Ciancio Gaetano, Gonzalez Javier
Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States.
Department of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United States.
Front Surg. 2020 Dec 18;7:622110. doi: 10.3389/fsurg.2020.622110. eCollection 2020.
Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood transfusion. A transplant-based (TB) approach to these tumors in JWs would result a safe surgical method, providing limited blood loss and perioperative complications. We report our experience using a TB surgical approach in JW harboring large adrenal/renal tumors with/without tumor thrombus trying to determine its usefulness in this setting. From 2003 to 2011, 7 patients underwent resection of renal/adrenal tumors with/without tumor thrombus in the IVC by means of a TB approach. Thrombus level was renal ( = 2), retrohepatic ( = 1), and suprahepatic ( = 1). The remaining 3 patients did not present thrombus. No pre-operative optimization or cell-saver were used. Estimated blood loss, perioperative complications (Clavien-Dindo and cause), hemoglobin/hematocrit loss, and length of stay were considered main outcomes. The intervention was successfully completed without transfusion in all cases. Operative time and blood loss were 2.5 h (range: 1.83-5.75) and 150 cc (range: 100-750), respectively. No major post-operative complications were registered. However, minor complications were detected in 57% of the patients included. Median hemoglobin loss was 1.13 mg/dL, which translated a median hematocrit loss of 2.3%. Patients were discharged in a median of 7 days (range 5-20). A TB-surgical approach provides enhanced retroperitoneal exposure and optimal vascular control, thus limiting operative blood loss or major complication development, thus resulting useful in JWs.
伴有或不伴有下腔静脉（IVC）瘤栓的肾肿瘤和肾上腺肿瘤，因有大出血和肿瘤血栓栓塞的风险，给外科医生带来了挑战。对于拒绝输血的耶和华见证会（JW）患者，情况更为危急。对JW患者的这些肿瘤采用基于移植的（TB）方法，将产生一种安全的手术方式，减少失血和围手术期并发症。我们报告了我们在患有伴有或不伴有瘤栓的大型肾上腺/肾肿瘤的JW患者中使用TB手术方法的经验，试图确定其在这种情况下的实用性。2003年至2011年，7例患者通过TB方法切除了伴有或不伴有IVC瘤栓的肾/肾上腺肿瘤。瘤栓水平为肾静脉（2例）、肝后（1例）和肝上（1例）。其余3例患者无瘤栓。未进行术前优化或使用血液回收机。估计失血量、围手术期并发症（Clavien-Dindo分级及原因）、血红蛋白/血细胞比容损失和住院时间被视为主要结局。所有病例均成功完成干预，未输血。手术时间和失血量分别为2.5小时（范围：1.83 - 5.75小时）和150毫升（范围：100 - 750毫升）。未记录到重大术后并发症。然而，57%的纳入患者检测到轻微并发症。血红蛋白中位数损失为1.13mg/dL，这相当于血细胞比容中位数损失2.3%。患者中位出院时间为7天（范围5 - 20天）。TB手术方法可增强腹膜后暴露并实现最佳血管控制，从而限制手术失血或重大并发症的发生，因此对JW患者有用。
