Radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass

Abstract

This study aimed to report on the experience of a single surgeon in a regional Australian centre with radical nephrectomy and vena caval thrombectomy with the use of cardiopulmonary bypass. Fifteen consecutive patients undergoing radical nephrectomy and vena caval thrombectomy with cardiopulmonary bypass over a 13-year period were identified. Retrospective analysis of prospectively collected data was used. Data were collected on intra-operative and pathological findings as well as post-operative complications. Oncological outcomes and long-term follow-up were analysed retrospectively in this study. All patients had a radical nephrectomy and vena caval thrombectomy with cardiopulmonary bypass. The median operating time was 336 min (mean 326.1 min), and median transfusion of packed red blood cells was 8 units (mean 6.9). The median bypass time was 107 min (mean 112.3 min), and the median circulation arrest time was 25 min (mean 25.3 min). Median length of hospital stay was 11 days (mean 14.5 days). Minor complications were seen in two patients and major complications seen in six, with one intra-operative death. Disease recurrence was seen in 1 of 14 patients who were considered completely resected at the time of operation. The overall 5-year survival rate was 84%. Median follow-up was 32 months (range 0-158). Median survival time was 135 months. Radical nephrectomy with caval thrombectomy with cardiopulmonary bypass can be performed in a regional centre with acceptable post-operative morbidity and mortality. Long-term survival is possible in some patients.