1. Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis
- Author
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Philipp Mandel, Martin Spahn, Daniel Vergho, Javier Carrascosa González, Estefanía Linares Espinós, G. Novara, Carlo Terrone, Eric Wallen, Siamak Daneshmand, Juan Palou, Christopher P. Evans, Paul Russo, James M. McKiernan, Raj S. Pruthi, Viraj A. Master, Gaetano Ciancio, Francesco Montorsi, Evanguelos Xylinas, Joaquín Carballido, J.I. Martínez-Salamanca, William C. Huang, Douglas S. Scherr, Paolo Gontero, Shahrokh F. Shariat, Oscar Rodriguez-Faba, Marc A. Dall'Era, Hao G. Nguyen, Blythe Durbin-Johnson, Markus Hohenfellner, John A. Libertino, Derya Tilki, Thomas F. Chromecki, Richard Zigeuner, Thenappan Chandrasekar, S. Pahernik, Axel Haferkamp, Nguyen Hao, G., Tilki, Derya, Dall'Era Marc, A., Durbin Johnson, Blythe, Carballido Joaquin, A., Chandrasekar, Thenappan, Chromecki, Thoma, Ciancio, Gaetano, Daneshmand, Siamak, Gontero, Paolo, Gonzalez, Javier, Haferkamp, Axel, Hohenfellner, Marku, Huang William, C., Linares Espinos, Estefania, Mandel, Philipp, Martinez Salamanca Juan, I., Master Viraj, A., McKiernan James, M., Montorsi, Francesco, Novara, Giacomo, Pahernik, Sascha, Palou, Juan, Pruthi Raj, S., Rodriguez Faba, Oscar, Russo, Paul, Scherr Douglas, S., Shariat Shahrokh, F., Spahn, Martin, Terrone, Carlo, Vergho, Daniel, Wallen Eric, M., Xylinas, Evanguelo, Zigeuner, Richard, Libertino John, A., and Evansk Christopher, P.
- Subjects
Male ,Vena Cava ,medicine.medical_treatment ,inferior ,carcinoma ,Neoplastic Cells ,Nephrectomy ,law.invention ,law ,Circulating ,intraoperative complications ,Thrombectomy ,Venous Thrombosis ,Cardiopulmonary Bypass ,Medicine (all) ,Middle Aged ,Neoplastic Cells, Circulating ,Kidney Neoplasms ,cardiopulmonary bypass ,renal cell ,survival ,vena cava ,Carcinoma, Renal Cell ,Female ,Humans ,Retrospective Studies ,Survival Rate ,United States ,Vena Cava, Inferior ,Urology ,medicine.vein ,Inferior ,medicine.medical_specialty ,Inferior vena cava ,Article ,medicine ,Cardiopulmonary bypass ,Survival rate ,business.industry ,Proportional hazards model ,Renal Cell ,Retrospective cohort study ,Perioperative ,Surgery ,Complication ,business - Abstract
The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass.We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses.Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study.In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.
- Published
- 2015