Surgical Management, Complications, and Outcome of Radical Nephrectomy with Inferior Vena Cava Tumor Thrombectomy Facilitated by Vascular Bypass

Abstract

To describe the technique, complications, and outcomes of vascular bypass during radical nephrectomy and tumor thrombectomy for patients with renal cell carcinoma and venous tumor thrombus. The indications and results for venovenous bypass (VVB) versus cardiopulmonary bypass (CPB) were reviewed as well. We identified 41 patients who had undergone radical nephrectomy and thrombectomy requiring VVB (n = 13) or CPB (n = 28) at our institution from 1970 to 2005 for renal cell carcinoma with venous tumor thrombus. The clinicopathologic variables and complication rates were compared between the VVB and CPB patients. The postoperative cancer-specific survival was estimated using the Kaplan-Meier method and compared using the log-rank test. The patients undergoing VVB experienced significantly shorter median bypass times (P = 0.015), operative times (P <0.001), and anesthesia times (P <0.001) compared with those treated with CPB. In addition, VVB was associated with trends toward decreased median intraoperative blood loss (1200 mL versus 2725 mL, P = 0.336), decreased blood/blood products transfused (median 2300 mL versus 4275 mL, P = 0.256), and decreased length of hospitalization (median 7 days versus 9 days, P = 0.078). The 5-year cancer-specific survival rate was not significantly different for patients undergoing VVB (29.8%) versus those treated with CPB (36.4%; P = 0.989). VVB was associated with significantly shorter bypass, operative, and anesthesia times, as well as trends toward decreased blood loss and hospital stay. Although the choice of bypass technique must be individualized according to the assessment of the bulk of thrombus to be resected, our results support the continued use of VVB in the management of renal cell carcinoma with extensive venous tumor thrombus, when appropriate.