title: Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis.
abstract: OBJECTIVE
  The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass.
  
  
  METHODS
  We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses.
  
  
  RESULTS
  Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study.
  
  
  CONCLUSIONS
  In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.
authors: Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
authors: Hao G
authors: HG
authors: Nguyen
authors: Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
authors: Derya
authors: D
authors: Tilki
authors: Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
authors: Marc A
authors: MA
authors: Dall'Era
authors: Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
authors: Blythe
authors: B
authors: Durbin-Johnson
authors: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Joaquín A
authors: JA
authors: Carballido
authors: Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
authors: Thenappan
authors: T
authors: Chandrasekar
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Thomas
authors: T
authors: Chromecki
authors: Miami Transplant Institute, University of Miami, Miami, FL, USA.
authors: Gaetano
authors: G
authors: Ciancio
authors: USC/Norris Comprehensive Cancer Center, Los Angeles, California, USA.
authors: Siamak
authors: S
authors: Daneshmand
authors: Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy.
authors: Paolo
authors: P
authors: Gontero
authors: Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain.
authors: Javier
authors: J
authors: Gonzalez
authors: Department of Urology, University of Frankfurt, Frankfurt, Germany.
authors: Axel
authors: A
authors: Haferkamp
authors: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors: Markus
authors: M
authors: Hohenfellner
authors: Department of Urology, New York University School of Medicine, New York, USA.
authors: William C
authors: WC
authors: Huang
authors: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Estefania Linares
authors: EL
authors: Espinós
authors: Institute of of Empirical Economic Research, University of Leipzig, Leipzig, Germany.
authors: Philipp
authors: P
authors: Mandel
authors: Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.
authors: Juan I
authors: JI
authors: Martinez-Salamanca
authors: Department of Urology, Emory University, Atlanta, Georgia, USA.
authors: Viraj A
authors: VA
authors: Master
authors: Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA.
authors: James M
authors: JM
authors: McKiernan
authors: Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy.
authors: Francesco
authors: F
authors: Montorsi
authors: University of Padua, Padua, Italy.
authors: Giacomo
authors: G
authors: Novara
authors: Department of Urology, University of Heidelberg, Heidelberg, Germany.
authors: Sascha
authors: S
authors: Pahernik
authors: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors: Juan
authors: J
authors: Palou
authors: Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA.
authors: Raj S
authors: RS
authors: Pruthi
authors: Department of Urology, Fundació Puigvert, Barcelona, Spain.
authors: Oscar
authors: O
authors: Rodriguez-Faba
authors: Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors: Paul
authors: P
authors: Russo
authors: Department of Urology, Weill Cornell Medical Center, New York, USA.
authors: Douglas S
authors: DS
authors: Scherr
authors: Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
authors: Shahrokh F
authors: SF
authors: Shariat
authors: University of Würzburg, Würzburg, Germany.
authors: Martin
authors: M
authors: Spahn
authors: Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy.
authors: Carlo
authors: C
authors: Terrone
authors: University of Würzburg, Würzburg, Germany.
authors: Daniel
authors: D
authors: Vergho
authors: Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA.
authors: Eric M
authors: EM
authors: Wallen
authors: Department of Urology, Weill Cornell Medical Center, New York, USA.|Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France.
authors: Evanguelos
authors: E
authors: Xylinas
authors: Department of Urology, Medical University of Graz, Graz, Austria.
authors: Richard
authors: R
authors: Zigeuner
authors: Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA.
authors: John A
authors: JA
authors: Libertino
authors: Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
authors: Christopher P
authors: CP
authors: Evans
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017131:Thrombectomy / Q000379:methods*; D014481:United States / Q000453:epidemiology; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*
keywords: carcinoma; cardiopulmonary bypass; inferior; intraoperative complications; renal cell; survival; vena cava