Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis.

Autor:	Nguyen HG; Department of Urology, UC Davis Medical Center, Sacramento, California, USA., Tilki D; Department of Urology, UC Davis Medical Center, Sacramento, California, USA., Dall'Era MA; Department of Urology, UC Davis Medical Center, Sacramento, California, USA., Durbin-Johnson B; Department of Urology, UC Davis Medical Center, Sacramento, California, USA., Carballido JA; Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain., Chandrasekar T; Department of Urology, UC Davis Medical Center, Sacramento, California, USA., Chromecki T; Department of Urology, Medical University of Graz, Graz, Austria., Ciancio G; Miami Transplant Institute, University of Miami, Miami, FL, USA., Daneshmand S; USC/Norris Comprehensive Cancer Center, Los Angeles, California, USA., Gontero P; Department of Urology, A.O.U. San Giovanni Battista, University of Turin, Turin, Italy., Gonzalez J; Department of Urology, Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain., Haferkamp A; Department of Urology, University of Frankfurt, Frankfurt, Germany., Hohenfellner M; Department of Urology, University of Heidelberg, Heidelberg, Germany., Huang WC; Department of Urology, New York University School of Medicine, New York, USA., Espinós EL; Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain., Mandel P; Institute of of Empirical Economic Research, University of Leipzig, Leipzig, Germany., Martinez-Salamanca JI; Department of Urology, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain., Master VA; Department of Urology, Emory University, Atlanta, Georgia, USA., McKiernan JM; Department of Urology, Columbia University College of Physicians and Surgeons, New York, USA., Montorsi F; Department of Urology, Hospital San Raffaele, University Vita-Salute, Milano, Italy., Novara G; University of Padua, Padua, Italy., Pahernik S; Department of Urology, University of Heidelberg, Heidelberg, Germany., Palou J; Department of Urology, Fundació Puigvert, Barcelona, Spain., Pruthi RS; Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA., Rodriguez-Faba O; Department of Urology, Fundació Puigvert, Barcelona, Spain., Russo P; Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Scherr DS; Department of Urology, Weill Cornell Medical Center, New York, USA., Shariat SF; Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Spahn M; University of Würzburg, Würzburg, Germany., Terrone C; Division of Urology, Maggiore della Carita Hospital, University of Eastern Piedmont, Novara, Italy., Vergho D; University of Würzburg, Würzburg, Germany., Wallen EM; Department of Urology, UNC at Chappel Hill, Chapel Hill, North Carolina, USA., Xylinas E; Department of Urology, Weill Cornell Medical Center, New York, USA.; Department of Urology, Cochin Hospital, APHP, Paris Descartes University, Paris, France., Zigeuner R; Department of Urology, Medical University of Graz, Graz, Austria., Libertino JA; Department of Urology, Lahey Clinic, Burlington, Massachusetts, USA., Evans CP; Department of Urology, UC Davis Medical Center, Sacramento, California, USA.
Jazyk:	angličtina
Zdroj:	The Journal of urology [J Urol] 2015 Aug; Vol. 194 (2), pp. 304-308. Date of Electronic Publication: 2015 Mar 19.
DOI:	10.1016/j.juro.2015.02.2948
Abstrakt:	Purpose: 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. Materials and 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. (Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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