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

• Type of Material: Article
• Authors: Hao G. Nguyen, University of California, Davis; Derya Tilki, University of California, Davis; Marc A. Dall'Era, University of California, Davis; Blythe Durbin-Johnson, University of California, Davis; Joaquín A. Carballido, Universidad Autónoma de Madrid; Thenappan Chandrasekar, University of California, Davis; Thomas Chromecki, Medical University of Graz; Gaetano Ciancio, University of Miami; Siamak Daneshmand, USC/Norris Comprehensive Cancer Center; Paolo Gontero, University of Turin; Javier Gonzalez, Hospital Central de la Cruz Roja San José y Santa Adela; Axel Haferkamp, University of Frankfurt; Markus Hohenfellner, University of Heidelberg; William C. Huang, New York University; Estefania Linares Espinós, Universidad Autónoma de Madrid; Philipp Mandel, University of Leipzig; Juan I. Martinez-Salamanca, Universidad Autónoma de Madrid; Viraj Master, Emory University; James M. McKiernan, Columbia University; Francesco Montorsi, University Vita-Salute; Giacomo Novara, University of Padua; Sascha Pahernik, University of Heidelberg; Juan Palou, Fundació Puigvert; Raj S. Pruthi, University of North Carolina; Oscar Rodriguez-Faba, Fundació Puigvert; Paul Russo, Memorial Sloan Kettering Cancer Center; Douglas S. Scherr, Weill Cornell Medical Center; Shahrokh F. Shariat, Medical University of Vienna; Martin Spahn, University of Würzburg; Carlo Terrone, University of Eastern Piedmont; Daniel Vergho, University of Würzburg; Eric M. Wallen, University of North Carolina; Evanguelos Xylinas, Weill Cornell Medical Center; Richard Zigeuner, Medical University of Graz; John A. Libertino, Lahey Clinic; Christopher P. Evans, University of California, Davis
• Language: English
• Date: 2015-08-01
• Publisher: Elsevier: Journal of Urology
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Urological Association Education and Research, Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.juro.2015.02.2948
• Title of Journal or Parent Work: Journal of Urology, The
• ISSN: 0022-5347
• Volume: 194
• Issue: 2
• Start Page: 304
• End Page: 308
• Keywords: Science & Technology; CANCER; COMPLICATIONS; Urology & Nephrology; EXTENSION; RADICAL NEPHRECTOMY; survival; SURGICAL-MANAGEMENT; inferior vena cava; Life Sciences & Biomedicine; RENAL-CELL CARCINOMA; renal cell carcinoma; VENOUS TUMOR THROMBUS; surgical complication; cardiopulmonary bypass; vena cava tumor thrombus; intraoperative complications; EXPERIENCE
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

Abstract

Purpose: The impact of cardiopulmonary bypass (CPB) usage in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We sought to determine the impact of cardiopulmonary bypass (CPB) 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 CPB. Patients and Methods: We retrospectively analyzed 362 patients with RCC and with level III or IV tumor thrombus from 1992 to 2012 in 22 US and European centers. Cox proportional hazards models were used to compare overall and cancer-specific survival between patients with and without CPB. Perioperative mortality and complications rates were assessed using logistic regression analyses. Results: The median overall survival was 24.6 months in non-CPB patients and 26.6 months in CPB patients. Overall survival and cancer-specific survival (CSS) did not differ significantly in both groups, neither in univariate analysis nor when adjusting for known risk factors. In multivariate analysis, no significant differences were seen in hospital LOS, Clavien 1-4 complication rate, intraoperative or 30 day mortality, and CSS between both groups. 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 in the multivariate analysis. Higher surgical complications were not independently associated with the use of CPB.