Imazuru Tomohiro, Uchiyama Masateru, Shimokawa Tomoki
Department of Cardiovascular Surgery, Teikyo University, Tokyo, Japan.
Heart Surg Forum. 2020 Feb 10;23(1):E025-E029. doi: 10.1532/hsf.2741.
Renal cell carcinoma (RCC) with tumor thrombus in the inferior vena cava (IVC) presents surgeons with a technical intraoperative challenge because of the need for aggressive surgical management. In this study, we describe our method for surgical management with cardiopulmonary bypass (CPB) and investigate the long-term outcomes of RCC patients with and without CPB.
Fifteen patients with RCC underwent nephrectomy and IVC thrombectomy from May 2011 to December 2017. We retrospectively reviewed and analyzed the clinical course of all patients. Novick classification was used to assess the level of tumor thrombus extension into the IVC. Patient characteristics, surgical procedures, and postoperative outcome data in both groups were collected.
Twelve patients were male and 3 were female, with an average age of 62.9 ± 10.9 years (range 46 to 82). The average operative times were 824 ± 335 minutes in the patients with CPB and 646 ± 162 minutes in those without CPB (P = .17). The average amount of intraoperative bleeding was 2125 ± 1315 ml in the patients with CPB and 3333 ± 1431 ml in those without CPB (P = .14). The same tendency was observed in patients of Novick levels 3 and 4. The mean observation period was 1061.4 days. No 30-day mortality was noted. There was no significant difference in all-cause survival between the patients with CPB and those without.
We conclude that surgical management with CPB and circulatory arrest may be a viable and safe method of treatment for RCC patients.
肾细胞癌（RCC）合并下腔静脉（IVC）肿瘤血栓给外科医生带来了术中技术挑战，因为需要积极的手术治疗。在本研究中，我们描述了我们采用体外循环（CPB）进行手术治疗的方法，并调查了接受和未接受CPB的RCC患者的长期结局。
2011年5月至2017年12月，15例RCC患者接受了肾切除术和IVC血栓切除术。我们回顾性地审查和分析了所有患者的临床病程。采用诺维克分类法评估肿瘤血栓延伸至IVC的水平。收集两组患者的特征、手术过程和术后结局数据。
12例为男性，3例为女性，平均年龄62.9±10.9岁（范围46至82岁）。接受CPB的患者平均手术时间为824±335分钟，未接受CPB的患者平均手术时间为646±162分钟（P = 0.17）。接受CPB的患者术中平均出血量为2125±1315 ml，未接受CPB的患者术中平均出血量为3333±1431 ml（P = 0.14）。诺维克3级和4级患者也观察到相同趋势。平均观察期为1061.4天。未观察到30天死亡率。接受CPB和未接受CPB的患者全因生存率无显著差异。
我们得出结论，CPB和循环阻断的手术治疗可能是RCC患者一种可行且安全的治疗方法。
