Usefulness of cardiopulmonary bypass in reconstruction of inferior vena cava occupied by renal cell carcinoma tumor thrombus
| Autor: | Takasi Azami, Yoshiya Toyoda, Masato Yoshida, Masayosi Okada, Morihito Okada, Keiji Ataka, Hidetaka Wakiyama, Chojiro Yamashita |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male medicine.medical_specialty Vena Cava Inferior 030204 cardiovascular system & hematology Inferior vena cava law.invention 03 medical and health sciences Blood Vessel Prosthesis Implantation 0302 clinical medicine Renal cell carcinoma law medicine Cardiopulmonary bypass Humans Neoplasm Invasiveness cardiovascular diseases 030212 general & internal medicine Thrombus Vein Carcinoma Renal Cell Aged Cardiopulmonary Bypass business.industry Balloon catheter Thrombosis Middle Aged medicine.disease Kidney Neoplasms Surgery medicine.anatomical_structure Treatment Outcome medicine.vein cardiovascular system Female Radiology Renal vein Cardiology and Cardiovascular Medicine business |
| Zdroj: | Angiology. 50(1) |
| ISSN: | 0003-3197 |
| Popis: | Aggressive surgical treatment in renal cell carcinoma is still controversial. The aim of this paper is to assess inferior vena caval (IVC) reconstruction for suprahepatic vena caval renal cell carcinoma (RCC) tumor thrombus. Twelve patients with suprahepatic vena caval thrombus from renal cell carcinoma who underwent surgical repair with cardiopulmonary bypass were evaluated. The vena caval defect was reconstructed by direct suture, patch repair, or graft replacement. Of 12 patients undergoing partial cardiopulmonary bypass, tumor thrombus extended to the junction of the hepatic vein in three patients and to the right atrium in one. Tumor thrombus was removed manually or with balloon catheter. Tumor thrombus in the right atrium was removed during electrical ventricular fibrillation. Repair of the IVC was performed by direct suture of the IVC wall in two patients, patch repair with expanded polytetrafluoroethylene (EPTFE) graft in seven, and graft replacement with an EPTFE graft in three. There were no operative deaths and the only postoperative complication was one patient death from pulmonary emboli. The four patients with nonlocalized disease died within 2 years, but four patients lived for more than 3 years postoperatively. Survival was 37.5% at 3 years and 18.8% at 5 years by the Kaplan-Meier's method. Conclusions: (1) Partial cardiopulmonary bypass is useful for the control of bleeding when tumor thrombus in the IVC extends to the junction of the hepatic vein. (2) Nephrectomy with tumor thrombectomy of the IVC is valuable, and long-term survival is possible in patients without distant metastases or regional lymph node metastases. |
| Databáze: | OpenAIRE |
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