Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Oncology, URI, Urological Research Institute, Renal cancer Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Unit of Urology, University Vita-Salute San Raffaele, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Eur Urol. 2018 May;73(5):793-799. doi: 10.1016/j.eururo.2017.08.019. Epub 2017 Sep 13.
Radical nephrectomy (RN) and caval thrombectomy (CT) for renal cell carcinoma, with extracorporeal circulation (ECC) and deep hypothermic circulatory arrest (DHCA) is a challenging surgical approach.
To assess peri-operative and oncologic outcomes of renal cell carcinoma patients treated with RN and CT, using ECC and DHCA.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated 46 patients who underwent RN and CT using ECC and DHCA.
After retroperitoneal nodal dissection and RN, a cardiopulmonary bypass was placed and DHCA achieved. A combined approach through the abdomen and the thorax was described.
Perioperative and long-term survival outcomes were reported.
Median operative time and length of hospital stay were 545min and 22 d. Overall, 33 patients (72%) did not require any additional interventional or surgical treatment. Thirty-day and 90-d mortality were 11% (5/46) and 15% (7/46). The 1-yr, 2-yr, and 3-yr cancer specific mortality (CSM)-free survival rates were 77%, 62%, and 56%, respectively. After stratification, according to metastatic status at diagnosis, CSM-free survival rates were significantly lower for cM1 patients compared with cM0 patients (1-yr 46% vs 93%, 2-yr 23% vs 81%, 3-yr 23% vs 73%, p<0.01). Our study is limited by its retrospective and uncomparative nature.
RN with CT using ECC and DHCA is a challenging procedure which requires a dedicated multidisciplinary working team to minimise complications and maximise patients' outcomes.
Patients with kidney cancer and a thrombus within the inferior vena cava, which reaches above the diaphragm, can be treated with surgery. However, this kind of surgical treatment is challenging and requires a dedicated multidisciplinary team in order to accomplish the task.
肾癌根治术（RN）和腔静脉血栓切除术（CT）联合体外循环（ECC）和深低温停循环（DHCA）是一种具有挑战性的手术方法。
评估使用 ECC 和 DHCA 治疗肾癌患者的围手术期和肿瘤学结果。
设计、地点和参与者：我们回顾性评估了 46 例接受 RN 和 CT 联合 ECC 和 DHCA 治疗的患者。
在腹膜后淋巴结清扫和 RN 后，放置体外循环，实现 DHCA。描述了一种通过腹部和胸部联合的方法。
报告围手术期和长期生存结果。
中位手术时间和住院时间分别为 545 分钟和 22 天。总体而言，33 例（72%）患者无需任何额外的介入或手术治疗。30 天和 90 天死亡率分别为 11%（5/46）和 15%（7/46）。1 年、2 年和 3 年的癌症特异性死亡率（CSM）无复发生存率分别为 77%、62%和 56%。分层后，根据诊断时的转移状态，cM1 患者的 CSM 无复发生存率明显低于 cM0 患者（1 年 46%比 93%，2 年 23%比 81%，3 年 23%比 73%，p<0.01）。本研究的局限性在于其回顾性和非比较性。
使用 ECC 和 DHCA 的 RN 和 CT 是一种具有挑战性的手术，需要一个专门的多学科工作团队来最大限度地减少并发症并最大限度地提高患者的预后。
患有肾癌且下腔静脉内有血栓，且血栓已达膈肌以上的患者，可以通过手术进行治疗。但是，这种手术治疗具有挑战性，需要一个专门的多学科团队来完成任务。
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