Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and Faculty Hospital Hradec Kralove, Hradec Kralove, Czech Republic.
BJU Int. 2013 Mar;111(3 Pt B):E59-64. doi: 10.1111/j.1464-410X.2012.11515.x. Epub 2012 Sep 18.
What's known on the subject? and What does the study add? Surgical treatment of renal cell carcinoma (RCC) with tumour thrombus extending into the right atrium remains, despite its complexity and specific technical aspects, the only radical therapeutic option. This single-centre study, unique in size for this rare condition, reports early and late results over a period of 18 years. All patients were operated on using a standardised protocol with use of cardiopulmonary bypass and deep hypothermic circulatory arrest. Overall and cancer-specific cumulative survival was better than in other reports.
To evaluate the long-term results of radical surgical management of renal cell carcinoma (RCC) with tumour thrombus extension (TTE) level IV into the right atrium (RCC/TTE IV) in a large single-institution series.
Radical complex urological and cardio-surgical procedure was performed over a period of 18 years (1993-2010) on 21 patients with RCC/TTE IV. A radical nephrectomy was performed followed by sternotomy, institution of cardiopulmonary bypass and extraction of the intracardiac tumour thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Perioperative and postoperative variables, and long-term overall and cancer-specific survival using the Kaplan-Meier method were analysed.
In all patients, precise removal of tumour thrombus was accomplished in a bloodless field during DHCA. The mean (sd) duration of circulatory arrest was 16 (6) min at a mean hypothermia of 20 (3) °C. In-hospital mortality was 9.5% (two patients). The median survival (including in-hospital mortality) was 25 months. In Kaplan-Meier analysis, 2- and 5-year overall cumulative survival rate was 57 (95% confidence interval, CI 36-78)% and 37 (95% CI 15-58)%, respectively. Cancer-specific cumulative survival was 68 (95% CI 49-89)% at 2 years and 51 (95% CI 28-74)% at 5 years.
Late outcome after radical surgical treatment in patients with RCC and TTE reaching up to the right atrium justifies this extensive procedure. Cardiopulmonary bypass with DHCA allows safe and precise extirpation of all intracaval and intracardiac tumour mass.
评估在一个大型单中心系列中，根治性手术治疗肾细胞癌（RCC）伴肿瘤血栓（TTE）延伸至右心房（RCC/TTE IV）的长期结果。
在 18 年期间（1993 年至 2010 年），对 21 例 RCC/TTE IV 患者进行了复杂的根治性泌尿科和心脏外科手术。首先进行根治性肾切除术，然后进行开胸术，建立体外循环，并在深低温循环停止（DHCA）期间直接直视下取出心内肿瘤血栓。分析围手术期和术后变量，以及使用 Kaplan-Meier 法的长期总体和癌症特异性生存率。
在所有患者中，在 DHCA 期间，在无血条件下精确地切除了肿瘤血栓。循环停止的平均（标准差）时间为 16（6）分钟，平均低温为 20（3）℃。院内死亡率为 9.5%（2 例）。中位生存时间（包括院内死亡率）为 25 个月。在 Kaplan-Meier 分析中，2 年和 5 年的总累积生存率分别为 57（95%置信区间，CI 36-78）%和 37（95%CI 15-58）%。2 年和 5 年时癌症特异性累积生存率分别为 68（95%CI 49-89）%和 51（95%CI 28-74）%。
在 RCC 伴 TTE 延伸至右心房的患者中，根治性手术治疗的晚期结果证明了这种广泛的手术是合理的。体外循环与 DHCA 相结合可安全、精确地切除所有腔静脉和心内肿瘤组织。
