Libertino John A, Ahmed Malik, Piemonte Thomas, Gee Jason
Department of Urology, Tufts University Medical Center, 800 Washington St., Boston, MA 02111, USA.
Department of Cardiology, Lahey Medical Center, Burlington, MA 01805, USA.
Cancers (Basel). 2025 Jan 15;17(2):264. doi: 10.3390/cancers17020264.
Renal cell carcinoma tends to invade venous structures, frequently extending beyond the inferior vena cava and into the heart itself, such as into the right atrium or right ventricle. Resection of tumor burden, particularly tumor thrombus, often requires cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA), which is not feasible for all patients.
Described in this study is a novel, minimally invasive endovascular approach involving endovascular thrombectomy as a viable approach in these select patients.
There were no surgical complications, shorter operating times, less blood loss and an average length of stay of 5.5 days in the four patients undergoing this procedure.
We demonstrate that this technique can eliminate the need for cardiac bypass and deep hypothermic cardiac arrest and its associated risks, thereby making surgery safer and more accessible for patients with advanced kidney cancers with an inferior vena cava tumor thrombus. Furthermore, it allows for this life-saving surgery to be carried out in medical centers or hospitals where cardiac surgery is unavailable, or when cardiopulmonary bypass is medically contraindicated.
肾细胞癌倾向于侵犯静脉结构，常延伸至下腔静脉以外并进入心脏本身，如进入右心房或右心室。切除肿瘤负荷，特别是肿瘤血栓，通常需要体外循环（CPB）和深低温停循环（DHCA），但并非所有患者都可行。
本研究描述了一种新型的微创血管内方法，即在这些特定患者中采用血管内血栓切除术作为一种可行的方法。
接受该手术的4例患者无手术并发症，手术时间缩短，失血少，平均住院时间为5.5天。
我们证明，该技术可消除心脏搭桥和深低温心脏停搏及其相关风险的需求，从而使患有下腔静脉肿瘤血栓的晚期肾癌患者的手术更安全、更容易进行。此外，它使得这种挽救生命的手术能够在没有心脏外科手术的医疗中心或医院进行，或者在体外循环存在医学禁忌时进行。
