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Extensive tumor resection under deep hypothermia and circulatory arrest
J H Chang1, J S Janik, J D Burrington
1Children's Hospital, Denver, CO.
Journal of Pediatric Surgery
|March 1, 1988
Summary
Deep hypothermia with cardiac arrest enables complete surgical resection of complex hepatic malignancies and Wilms' tumors. This technique provides a bloodless field, facilitating precise tumor removal and improving patient outcomes in challenging cases.
Area of Science:
- Surgical Oncology
- Cardiovascular Surgery
- Pediatric Surgery
Background:
- Complete resection of hepatic malignancies and Wilms' tumors with vascular extension is often limited by the risk of fatal hemorrhage.
- Traditional surgical approaches may be insufficient for tumors involving major vascular structures.
Purpose of the Study:
- To evaluate the efficacy and safety of deep hypothermia with cardiac arrest and exsanguination for complex hepatic and Wilms' tumor resections.
- To assess the feasibility of achieving complete tumor removal in challenging oncologic cases.
Main Methods:
- Utilized deep hypothermia (average 17°C) with cardiac arrest (average 39 minutes) and exsanguination for five hepatic and two intravenous Wilms' tumor resections.
- Performed initial hepatic resections in a bloodless field within 15 minutes, with immediate frozen section analysis for margin adequacy.
- Employed mattress sutures for hemorrhage control during recirculation and direct vision extraction for vascular-involved Wilms' tumors.
Main Results:
- Achieved complete resection in challenging hepatic malignancies, including trisegmentectomies and left lobectomies, with two cases requiring additional resection.
- Successfully removed Wilms' tumors with extensive vascular invasion into the inferior vena cava and right atrium in two pediatric patients.
- One patient experienced fatal bleeding and cardiac decompensation; another died from tumor recurrence. The two Wilms' tumor patients are reported as well.
Conclusions:
- Deep hypothermia with cardiac arrest and exsanguination is a viable technique for achieving complete resection in complex hepatic and vascular-involved Wilms' tumors.
- The technique facilitates a bloodless surgical field, enabling precise tumor removal and potentially improving oncologic outcomes.
- While effective, careful management of hemorrhage during recirculation and consideration of tumor recurrence are critical for patient survival.