Cardiopulmonary Bypass and Cancer Dissemination: A Logical But Unlikely Association

Braile, Domingo Marcolino; Évora, Paulo Roberto Barbosa

doi:10.21470/1678-9741-2018-0600

Cited by 6 publications

(6 citation statements)

References 4 publications

(3 reference statements)

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“…Finally, further research is needed to know whether the transient immunosuppression associated with CPB can promote the spread and growth of pre-existing cancer cells. However, adverse effects of CPB on cancer prognosis are expected but have not been confirmed [11,12] .…”

Section: Discussionmentioning

confidence: 99%

Right Atrium Tumor Extension Through the Inferior Vena Cava. Considerations About Nine Cases Operated Under Cardiopulmonary Bypass

Chaud¹,

Tucci²,

Bassetto³

et al. 2019

Braz J Cardiovasc Surg

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IntroductionAdrenocortical and renal cell carcinomas rarely invade the right atrium (RA). These neoplasms need surgical treatment, are very aggressive and have poor prognostic and surgical outcomes.Case seriesWe present a retrospective cohort of nine cases of RA invasion through the inferior vena cava (four adrenocortical carcinomas and five renal cell carcinomas). Over 13 years (2002-2014), nine patients were operated in collaboration with the team of urologists. Surgery was possible in all patients with different degrees of technical difficulty. All patients were operated considering the imaging examinations with the aid of CPB. In all reported cases (renal or suprarenal), the decision to use CPB with deep hypothermic circulatory arrest (DHCA) on surgical strategy was decided by the team of urological and cardiac surgeons.ConclusionData retrospectively collected from patients of public hospitals reaffirm: 1) Low incidence with small published series; 2) The selected cases did not represent the whole historical casuistry of the hospital, since they were selected after the adoption of electronic documentation; 3) Demographic data and references reported in the literature were presented as tables to avoid wordiness; 4) The series highlights the propensity to invade the venous system; 5) Possible surgical treatment with the aid of CPB in collaboration with the urology team; 6) CPB with DHCA is a safe and reliable option; 7) Poor prognosis with disappointing late results, even considering the adverse effects of CPB on cancer prognosis are expected but not confirmed.

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Section: Discussionmentioning

confidence: 99%

Right Atrium Tumor Extension Through the Inferior Vena Cava. Considerations About Nine Cases Operated Under Cardiopulmonary Bypass

Chaud¹,

Tucci²,

Bassetto³

et al. 2019

Braz J Cardiovasc Surg

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“…So, it seems reasonable that CS with or without CPB remains within the arsenal of therapies for this population, especially in treated or stable malignancy cases. Principally, given that there is no definitive proof that CS with CPB can either increase dissemination or survival (45).…”

Section: A Logical But Unlikely Associationmentioning

confidence: 99%

Cardiopulmonary bypass and cancer dissemination and progression: myth reality, enigma, puzzle?

Li¹,

Wada²,

Évora³

2023

Curr Chall Thorac Surg

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Cardiac disease (CD) and oncologic disease (OD) are among the most lethal diseases. Both share common risk factors and as a consequence, there are a substantial number of patients who need surgeries for problems related to both diseases. Treatments for OD should start as soon as possible, as the disease can progress and disseminate, reducing life expectancy for patients. At times, heart problems may need cardiac surgery (CS), which are sophisticated and peculiar, at many times needing a machine to do the lung and the heart function as the surgeon does his job. This is called cardiopulmonary bypass (CPB), a procedure that is known to be related to inflammation and immunosuppression syndromes, that could lead the cancer disease to disseminate. There is little information on this subject in the literature so, in this narrative review, we have made a literature review, trying to address whether this theoretical worry confirms at evidencebased medicine. We also described some considerations regarding the use of devices like Cell Saver ® and autotransfusion in oncologic patients. Further, we have taken some considerations about what care should be taken when facing situations with patients of different stages of OD needing CS and what should be discussed multidisciplinary aiming a treatment that best fits patient's life-expectancy and clinical status.

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“…Certainly, surgical stress was ascertained to affect the immune system, resulting in increasing tumor recurrence. This may be the pathogenetic cause which explains CBP and cancer relation [50]. To date, CBP is not likely to cause tumor progression.…”

Section: Scenario 3 Active Cancer and Severe Symptomatic Aortic Valve Stenosismentioning

confidence: 99%

Active cancer and cardiac surgery: Possible scenarios in patient decision-making

Bonelli

Lorusso

París

et al. 2021

Monaldi Arch Chest Dis

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Heart disease and cancer are often found simultaneously in the same patient, and may require cardiac and non-cardiac surgery. Cancer may be part of the past medical history; in other cases the presence of an active malignancy makes the clinical management more complex. No general evidence-based recommendations are available to help in the decision-making process. Because of the lack of specific guidelines we provided a series of possible scenarios describing not unusual cases. We focused on cases where the concomitant presence of heart disease and active malignancies involved a multidisciplinary team. Four real patients with active cancer referred to our Center were assessed. Three of them had valve disease requiring cardiac surgery. Defining the timing of surgery and choosing the surgical approach required a careful and comprehensive evaluation. In the last case, the complicated balance between the thrombotic and the hemorrhagic risk involved difficult decision. Several critical points, which characterized the management of this kind of patients, were identified. In particular, the hemodynamic status, the type and stage of the tumor, the need for cancer therapy, as well as the comorbidities of the patient, had to be taken into account. This narrative review shows the importance of submitting every challenging case to the assessment of a multidisciplinary team, which involves different clinical figures, in order to guarantee the most comprehensive evaluation. When clinical management deviates from the general recommendations, an individualized approach should be used.

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Cardiopulmonary Bypass and Cancer Dissemination: A Logical But Unlikely Association

Cited by 6 publications

References 4 publications

Right Atrium Tumor Extension Through the Inferior Vena Cava. Considerations About Nine Cases Operated Under Cardiopulmonary Bypass

Right Atrium Tumor Extension Through the Inferior Vena Cava. Considerations About Nine Cases Operated Under Cardiopulmonary Bypass

Cardiopulmonary bypass and cancer dissemination and progression: myth reality, enigma, puzzle?

Active cancer and cardiac surgery: Possible scenarios in patient decision-making

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