Presentation Authors: Hai Bi*, Guoliang Wang, Yi Huang, Lulin Ma, Beijing, China, People's Republic of
Introduction: Curative surgery is the only reasonable chance for the cure of renal cell carcinoma with supradiaphragmatic tumor thrombus. However, sternotomy, cardiopulmonary bypass (CBP) as well as deep hypothermic circulatory arrest (DHCA) significantly increased the chances of perioperative morbidity and mortality. Here, we described our modified surgical technique to remove the supradiapharagmatic tumor thrombus through an abdominal incision without sternotomy, CBP and DHCA, and investigated the safety and effective of this technique.
Methods: Between April 2015 and January 2018, we enrolled eight patients from our hospital, who underwent radical nephrectomy with removal of a level IV tumor thrombus through an abdominal incision using a transdiaphragmatic approach. Sternotomy, CBP and DHCA were not used. All clinical information, including patient demographics, operative variables and postoperative outcomes were retrospectively reviewed and analyzed.
Results: All patients were operated successfully without the use of sternotomy, CBP and DHCA. The median operative time was 7 hours 23.2 minutes. Median estimated blood loss was 2950mL. All patients received blood transfusion with median blood infusion of 2150mL. Two patients with Buddi-Chiari syndrome preoperative developed postoperative hydrothorax resulting from pleuro-abdominal fistula. All patients were alive at the last follow-up during a follow-up of 3.5 to 36 months. One patient experienced metastatic progression disease 1 year after surgery.
Conclusions: Our experience revealed that this technique was effective and safety in selected patients with supradiaphragmatic tumor thrombus. However, patients with a large amount of ascitic fluid resulting from Buddi-Chiari syndrome should be alert to develop hydrothorax postoperatively resulting from pleuro-abdominal fistula.