Cavoatrial tumor thrombectomy using cardipulmonary bypass without circulatory arrest

Area of Science:

• Oncology
• Cardiovascular Surgery
• Nephrology

Background:

• Inferior vena cava (IVC) tumor thrombus presents a significant surgical challenge.
• Supradiaphragmatic extension necessitates complex management strategies.
• Tumors commonly include renal cell carcinoma, Wilms' tumor, and others.

Purpose of the Study:

• To evaluate the safety and efficacy of surgical intervention for IVC tumor thrombus.
• To compare outcomes between different surgical techniques, including cardiopulmonary bypass (CPB).
• To assess the role of moderate hypothermia versus profound hypothermia and circulatory arrest.

Main Methods:

• Retrospective analysis of 29 patients with IVC tumor thrombus, 14 undergoing surgery.
• Surgical groups: unresectable (A), thrombectomy without CPB (B), and thrombectomy with CPB (C).
• All patients received CPB with moderate hypothermia and IVC interruption; CPB was used in 8 patients (Group C).

Main Results:

• No perioperative deaths occurred.
• Transient neurological impairment in 2 patients; coagulopathy in 2 patients.
• Median survival: 41 months (Group B) vs. 17 months (Group C).

Conclusions:

• Surgical resection of IVC tumor thrombus is achievable.
• Moderate hypothermia with CPB provides adequate visualization and excision, avoiding complications of circulatory arrest.
• This approach is associated with acceptable morbidity and potential for long-term survival.