title: Effect of utilization of veno-venous bypass vs. cardiopulmonary bypass on complications for high level inferior vena cava tumor thrombectomy and concomitant radical nephrectomy.
abstract: OBJECTIVE
  To determine if patients with renal cell carcinoma (RCC) with levels III and IV tumor thrombi are receive any reduction in complication rate utilizing veno-venous bypass (VVB) over cardiopulmonary bypass (CPB) for high level (III/IV) inferior vena cava (IVC) tumor thrombectomy and concomitant radical nephrectomy.
  
  
  METHODS
  From May 1990 to August 2011, we reviewed 21 patients that had been treated for RCC with radical nephrectomy and concomitant IVC thrombectomy employing either CPB (n =16) or VVB (n=5). We retrospectively reviewed our study population for complication rates and perioperative characteristics.
  
  
  RESULTS
  Our results are reported using the validated Dindo-Clavien Classification system comparing the VVB and CPB cohorts. No significant difference was noted in minor complication rate (60.0% versus 68.7%, P=1.0), major complication rate (40.0% versus 31.3%, P=1.0), or overall complication rate (60.0% versus 62.5%, P=1.0) comparing VVB versus CPB. We also demonstrated a trend towards decreased time on bypass (P=0.09) in the VVB cohort.
  
  
  CONCLUSIONS
  The use of VVB over CPB provides no decrease in minor, major, or overall complication rate. The use of VVB however, can be employed on an individualized basis with final decision on vascular bypass selection left to the discretion of the surgeon based on specifics of the individual case.
authors.affiliation: University of South Florida, Department of Urology, Tampa, FL, USA.
authors.forename: Ross M
authors.initials: RM
authors.lastname: Simon
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Espiritu
authors.affiliation: University of South Florida, Department of Urology, Tampa, FL, USA.
authors.forename: Tony
authors.initials: T
authors.lastname: Kurian
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Wade J
authors.initials: WJ
authors.lastname: Sexton
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Julio M
authors.initials: JM
authors.lastname: Pow-Sang
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Einar
authors.initials: E
authors.lastname: Sverrisson
authors.affiliation: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Spiess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D059035:Perioperative Period; D011183:Postoperative Complications; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*