Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, 351100, Fujian, People's Republic of China.
Surg Today. 2022 Aug;52(8):1125-1133. doi: 10.1007/s00595-021-02429-9. Epub 2022 Jan 3.
The present report discusses the indications of cardiopulmonary bypass (CPB) in open nephrectomy and surgical outcomes of conventional and minimally invasive surgical techniques for treating advanced renal cell carcinoma with inferior vena cava tumor thrombus.
The present study involved a comprehensive retrieval of pertinent literature from the most recent two decades.
Comparisons between radical nephrectomy procedures in terms of open, laparoscopic and robotic-assisted surgeries revealed that open surgery had more blood loss, a longer operation time and higher mortality rates than laparoscopic and robotic-assisted surgeries. Furthermore, surgery with CPB was associated with more blood loss than non-CPB surgery. Rates of early and late deaths were much higher in patients with CPB than in those without CPB.
Different surgical techniques had different indications in terms of levels of inferior vena cava tumor thrombus. The laparoscopic, robotic-assisted, open surgical techniques and CPB with deep hypothermic circulatory arrest were indicated for Levels I, II, III and III-IV inferior vena cava tumor thrombus, respectively. Laparoscopic and robotic-assisted surgeries cause less trauma than open surgery but require more complicated equipments to support the procedure. CPB should be avoided in radical nephrectomy whenever possible. The increased application of laparoscopic and robotic techniques in the future is anticipated.
本报告讨论了体外循环（CPB）在开放性肾切除术的适应证，以及传统和微创外科技术治疗下腔静脉肿瘤血栓合并晚期肾细胞癌的手术结果。
本研究对最近二十年的相关文献进行了全面检索。
开放性、腹腔镜和机器人辅助手术的根治性肾切除术比较显示，开放性手术的出血量、手术时间和死亡率均高于腹腔镜和机器人辅助手术。此外，CPB 手术的出血量多于非 CPB 手术。CPB 组的早期和晚期死亡率均明显高于非 CPB 组。
不同的手术技术在下腔静脉肿瘤血栓水平方面具有不同的适应证。腹腔镜、机器人辅助、开放性手术和 CPB 联合深低温停循环分别适用于 I 型、II 型、III 型和 III-IV 型下腔静脉肿瘤血栓。腹腔镜和机器人辅助手术比开放性手术创伤小，但需要更复杂的设备来支持手术。CPB 应尽可能避免用于根治性肾切除术。预计未来腹腔镜和机器人技术的应用将会增加。
