TY - JOUR
T1 - Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy
T2 - Multi-Institutional Analysis
AU - Nguyen, Hao G.
AU - Tilki, Derya
AU - Dall'Era, Marc A.
AU - Durbin-Johnson, Blythe
AU - Carballido, Joaquín A.
AU - Chandrasekar, Thenappan
AU - Chromecki, Thomas
AU - Ciancio, Gaetano
AU - Daneshmand, Siamak
AU - Gontero, Paolo
AU - Gonzalez, Javier
AU - Haferkamp, Axel
AU - Hohenfellner, Markus
AU - Huang, William C.
AU - Linares Espinós, Estefania
AU - Mandel, Philipp
AU - Martinez-Salamanca, Juan I.
AU - Master, Viraj A.
AU - McKiernan, James M.
AU - Montorsi, Francesco
AU - Novara, Giacomo
AU - Pahernik, Sascha
AU - Palou, Juan
AU - Pruthi, Raj S.
AU - Rodriguez-Faba, Oscar
AU - Russo, Paul
AU - Scherr, Douglas S.
AU - Shariat, Shahrokh F.
AU - Spahn, Martin
AU - Terrone, Carlo
AU - Vergho, Daniel
AU - Wallen, Eric M.
AU - Xylinas, Evanguelos
AU - Zigeuner, Richard
AU - Libertino, John A.
AU - Evans, Christopher P.
N1 - Publisher Copyright:
© 2015 American Urological Association Education and Research, Inc.
PY - 2015
Y1 - 2015
N2 - Purpose 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. Materials and Methods 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. Results 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. Conclusions 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.
AB - Purpose 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. Materials and Methods 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. Results 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. Conclusions 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.
KW - carcinoma
KW - cardiopulmonary bypass
KW - inferior
KW - intraoperative complications
KW - renal cell
KW - survival
KW - vena cava
UR - http://www.scopus.com/inward/record.url?scp=84943364188&partnerID=8YFLogxK
U2 - 10.1016/j.juro.2015.02.2948
DO - 10.1016/j.juro.2015.02.2948
M3 - Article
SN - 0022-5347
VL - 194
SP - 304
EP - 309
JO - Journal of Urology
JF - Journal of Urology
IS - 2
ER -