Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

Gorin, Michael A.; González, Javier; Garcia-Roig, Michael; Ciancio, Gaetano

doi:10.1016/j.urolonc.2012.06.013

Cited by 26 publications

(13 citation statements)

References 40 publications

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“…The broad variety of surgical strategies reflects the dilemma between securing the optimal surgical conditions at a price of DHCA or trying to decrease the procedural burden by avoiding DHCA, usually at a cost of extensive sub-and suprahepatic dissection to improve the vascular control of the operative field [24,25]. In our opinion, the safety and exactness of the tumour removal is the cornerstone of this radical surgery; however, there is no doubt that DHCA prolongs the duration of the procedure and negatively affects bleeding and inflammatory response.…”

Section: Discussionmentioning

confidence: 99%

Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium

Žáček

Dominik

Broďák

et al. 2014

Interactive CardioVascular and Thoracic Surgery

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Section: Discussionmentioning

confidence: 99%

Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium

Žáček

Dominik

Broďák

et al. 2014

Interactive CardioVascular and Thoracic Surgery

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“…In addition, CPB with or without DHCA can lead to hematologic (platelet dysfunction and coagulopathy) and neurologic complications. Also, extensive heparinization in CPB could result in uncontrollable bleeding from raw surgical surfaces (9, 10). Hence, avoiding CPB while not compromising the aims of the cancer surgery or the patient’s prognosis is a logical approach that should be pursued.…”

Section: Introductionmentioning

confidence: 99%

Supradiaphragmatic Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: A Case Series at a Single Center

et al. 2016

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IntroductionInferior vena cava tumor thrombectomy in renal cell carcinoma patients is a challenging procedure, frequently requiring the vascular bypass technique for high-level thrombi with additional complications. Adopting a technique such as intrapericardial control in selected cases will circumvent these problems. Here, we present the results of our intrapericardial control technique during supradiaphragmatic inferior vena caval tumor thrombectomy.Case PresentationThe records of six patients with supradiaphragmatic tumor thrombi, who underwent radical nephrectomy and thrombectomy at our center with intrapericardial control between the years 2008 and 2015, were retrospectively reviewed. The patients’ characteristics, intra- and postoperative data, histology, and follow-up records were gathered and compared. There were no immediate or 30-day postoperative deaths. The mean age of the patients was 61.3 years (range 46 - 75). The total mean duration of surgery was 315 minutes and the mean amount of transfused red blood cells was 4.33 units during surgery and 0.8 units in the postoperative period. The average hospitalization duration was 8 days (range 5 - 17). Tumor stage was T3 in four patients and T4 in two, due to ipsilateral adrenal involvement. The mean duration of follow-up was 33.5 months. Only one of the patients developed recurrences, first in the tumor bed and then at the site of the skin incision; these were excised with no apparent complications.ConclusionsRadical nephrectomy and tumor thrombectomy by intrapericardial control without cardiopulmonary bypass and hypothermic circulatory arrest is a safe and effective procedure that can avoid serious intra- and postoperative complications while providing acceptable cancer-control and mortality results.

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“…For borderline T3b/T3c renal tumors, classically, there is a need for cardio-pulmonary bypass and cardiac arrest in order to ensure a bloodless surgical field and optimum surgical comfort. However, this procedure implies a high risk of stroke and platelet dysfunction, resulting in the development of less-invasive bypass techniques together with more efficient approaches for renal resection (1,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Piggy-back Hepatic Transplant Technique and Veno-venous Bypass Without Cardiac Arrest: A Multidisciplinary Approach in Borderline T3b/T3c Renal Tumors

Nechifor-Boilă

Suciu

Loghin

et al. 2015

Acta Medica Marisiensis

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Surgery for renal cell carcinomas with tumor thrombus extending in the Inferior Vena Cava (IVC) can be particularly challenging, especially in the retrohepatic and intraatrial situations (T3b and T3c). Classically, these tumors require the intraoperative use of cardio-pulmonary by-pass (CPB) and deep hypothermic circulatory arrest (DHCA), that can result in specific complications (stroke, platelet dysfunction), with increased postoperative morbidity rates. In urological practice, a particular IVC preparation method is currently in use, allowing full control both upon the IVC and its tributaries. It is derived from the "piggy-back" liver transplantation technique and implies the resection of all hepatic ligaments, leaving the hepatic vascular connections intact. This procedure is joined by a form of veno-venous bypass (between the right atrium and the infrarenal IVC) that allows a constant central venous pressure (by assuring blood return), with less bleeding and without the need for CPB and DHCA (avoiding, in this way, their inherent complications). All in all, these recently-introduced procedures can offer better thrombus control, improved oncologic outcomes and smaller complication rates. We aim to present a case of borderline T3b/T3c renal tumor that was successfully treated in our university center using these techniques.

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Transplantation techniques for the resection of renal cell carcinoma with tumor thrombus: A technical description and review

Cited by 26 publications

References 40 publications

Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium

Selective aortic arch perfusion enables to avoid deep hypothermic circulatory arrest for extirpation of renal cell carcinoma with tumour thrombus extension into the right atrium

Supradiaphragmatic Inferior Vena Caval Thrombectomy Without Cardiopulmonary Bypass: A Case Series at a Single Center

Piggy-back Hepatic Transplant Technique and Veno-venous Bypass Without Cardiac Arrest: A Multidisciplinary Approach in Borderline T3b/T3c Renal Tumors

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