title: Resection of Intraabdominal Tumors With Cavoatrial Extension Using Deep Hypothermic Circulatory Arrest.
abstract: BACKGROUND
  Intraabdominal malignancies with cavoatrial extension can be resected using cardiopulmonary bypass and deep hypothermic circulatory arrest (DHCA).
  
  
  METHODS
  Twenty-five consecutive patients underwent resection of intraabdominal tumor with cavoatrial thrombectomy using DHCA at a single tertiary center. Recurrence-free survival, cancer-specific survival, and overall survival were estimated using Kaplan-Meier analysis.
  
  
  RESULTS
  All patients had renal artery embolization preoperatively. Procedures were performed through a median sternotomy with bilateral subcostal incision. Tumors were resected under DHCA. Mean age was 57 ± 14 years, 60% were hypertensive, 20% were diabetic, 16% had coronary disease, 44% were smokers, 16% had neoplastic pulmonary embolism, and the mean creatinine was 1.4 ± 0.75 mg/dL. Mean cardiopulmonary bypass, cross-clamp, and DHCA times were 137.4 ± 25.5, 33.2 ± 14.7, and 26.3 ± 13.8 minutes, respectively. R0 resection was achieved in 76% and R1 resection in 4%. Metastatic disease was present in 20%, and 8% had N1 disease. The pathologic diagnosis was renal cell carcinoma in 20 of 25 patients (80%) and adrenocortical carcinoma, Wilms tumor, adrenal melanoma, and spinal chordoma in 1 patient each. Operative mortality was 8%. Twelve percent needed hemodialysis, 8% had pneumonia, 4% stroke, and 8% required reexploration for bleeding. Mean follow-up time was 32.5 months. At last follow-up, 56% had died of disease and 28% were alive, 16% without evidence of disease. Actuarial 5-year survival for the entire cohort was 36%.
  
  
  CONCLUSIONS
  Intraabdominal malignancies with cavoatrial extension can be safely resected. Excellent local tumor control can be anticipated. Long-term surveillance is necessary to detect recurrence.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. Electronic address: ch19077@med.cornell.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lau
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Padraic
authors.initials: P
authors.lastname: O'Malley
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Mario
authors.initials: M
authors.lastname: Gaudino
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, New York.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D014682:Vena Cava, Inferior / Q000473:pathology*