Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus

Jordon G. Lubahn, Arthur I Sagalowsky, David H. Rosenbaum, Erkan Dikmen, Rehal A. Bhojani, Michelle C. Paul, Bart L. Dolmatch, Shellie C Josephs, Elie A. Benaim, Barry S. Levinson, Michael A Wait, W Steves Ring, J. Michael DiMaio

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension. Methods: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Results: There were 29 men and 17 women with a mean age of 60.2 ± 12.0 years. Twenty-five (54%) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96%) cases. Three (7%) patients underwent right heart venovenous bypass, and 2 (5%) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32%) patients had perioperative complications, including 1 (2%) perioperative death. Patients who required cardiovascular procedures (inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications (P < .02). The 1-, 2-, and 5-year overall survival rates were 78%, 69%, and 56%. Conclusions: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.

Original languageEnglish (US)
Pages (from-to)1289-1295
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume131
Issue number6
DOIs
StatePublished - Jun 2006

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Cardiovascular Surgical Procedures
Renal Cell Carcinoma
Thrombosis
Safety
Right Heart Bypass
Neoplasms
Nephrectomy
Cardiopulmonary Bypass
Survival
Morbidity
Thrombectomy
Venae Cavae
Inferior Vena Cava
Patient Rights
Constriction
Referral and Consultation
Survival Rate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus. / Lubahn, Jordon G.; Sagalowsky, Arthur I; Rosenbaum, David H.; Dikmen, Erkan; Bhojani, Rehal A.; Paul, Michelle C.; Dolmatch, Bart L.; Josephs, Shellie C; Benaim, Elie A.; Levinson, Barry S.; Wait, Michael A; Ring, W Steves; DiMaio, J. Michael.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 131, No. 6, 06.2006, p. 1289-1295.

Research output: Contribution to journalArticle

Lubahn, Jordon G. ; Sagalowsky, Arthur I ; Rosenbaum, David H. ; Dikmen, Erkan ; Bhojani, Rehal A. ; Paul, Michelle C. ; Dolmatch, Bart L. ; Josephs, Shellie C ; Benaim, Elie A. ; Levinson, Barry S. ; Wait, Michael A ; Ring, W Steves ; DiMaio, J. Michael. / Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus. In: Journal of Thoracic and Cardiovascular Surgery. 2006 ; Vol. 131, No. 6. pp. 1289-1295.
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abstract = "Objective: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension. Methods: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Results: There were 29 men and 17 women with a mean age of 60.2 ± 12.0 years. Twenty-five (54{\%}) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96{\%}) cases. Three (7{\%}) patients underwent right heart venovenous bypass, and 2 (5{\%}) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32{\%}) patients had perioperative complications, including 1 (2{\%}) perioperative death. Patients who required cardiovascular procedures (inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications (P < .02). The 1-, 2-, and 5-year overall survival rates were 78{\%}, 69{\%}, and 56{\%}. Conclusions: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.",
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T1 - Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus

AU - Lubahn, Jordon G.

AU - Sagalowsky, Arthur I

AU - Rosenbaum, David H.

AU - Dikmen, Erkan

AU - Bhojani, Rehal A.

AU - Paul, Michelle C.

AU - Dolmatch, Bart L.

AU - Josephs, Shellie C

AU - Benaim, Elie A.

AU - Levinson, Barry S.

AU - Wait, Michael A

AU - Ring, W Steves

AU - DiMaio, J. Michael

PY - 2006/6

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N2 - Objective: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension. Methods: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Results: There were 29 men and 17 women with a mean age of 60.2 ± 12.0 years. Twenty-five (54%) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96%) cases. Three (7%) patients underwent right heart venovenous bypass, and 2 (5%) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32%) patients had perioperative complications, including 1 (2%) perioperative death. Patients who required cardiovascular procedures (inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications (P < .02). The 1-, 2-, and 5-year overall survival rates were 78%, 69%, and 56%. Conclusions: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.

AB - Objective: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension. Methods: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed. Results: There were 29 men and 17 women with a mean age of 60.2 ± 12.0 years. Twenty-five (54%) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96%) cases. Three (7%) patients underwent right heart venovenous bypass, and 2 (5%) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32%) patients had perioperative complications, including 1 (2%) perioperative death. Patients who required cardiovascular procedures (inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications (P < .02). The 1-, 2-, and 5-year overall survival rates were 78%, 69%, and 56%. Conclusions: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.

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