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DOI: 10.1055/s-0036-1571681
Long-term Outcomes after Resection of Renal Tumors with Stage IV Cavoatrial Extension in Circulatory Arrest
Objectives: Renal neoplasms frequently expand into renal veins and inferior vena cava from the early stages of the disease. In this study we set out to define the long-term outcomes of the patients with stage IV tumorous cavoatrial extension, undergoing radical nephrectomy with excision of cavoatrial extension in deep hypothermic circulatory arrest (DHCA).
Methods: 35 patients with stage IV cavoatrial extension of renal cell carcinoma underwent radical nephrectomy combined with en-bloc excision of cavoatrial tumor-thrombus extension, performed in DHCA. The preoperative staging of the tumor and assessment of the intravascular position of the tumor were performed using standard imaging techniques, including CTA, MRI and echocardiography. Patient data were analyzed retrospectively and collected in the patient data bank.
Results: In our study cohort we could demonstrate acceptable long-term results and outline several clear predictors for good postoperative long-term survival of the patients. We show, that preoperative evidence of remote tumor metastases and tumorous lymph node involvement can predict inferior postoperative survival. Further, we describe high postoperative tumor recurrence rate in these patients, which is, however, not limiting the patient survival.
Conclusions: Our data provide strong evidence for perioperative safety and acceptable long-term results of radical nephrectomy with excision of cavoatrial extension in DHCA in patients with stage IV cavoatrial extension of renal neoplasm. Thus, this radical surgical procedure can be safely applied as a curative approach, taking into the consideration the negative impact of evident tumor metastases.