Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy
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Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy : Multi-Institutional Analysis. / Nguyen, Hao G; Tilki, Derya; Dall'Era, Marc A; Durbin-Johnson, Blythe; Carballido, Joaquín A; Chandrasekar, Thenappan; Chromecki, Thomas; Ciancio, Gaetano; Daneshmand, Siamak; Gontero, Paolo; Gonzalez, Javier; Haferkamp, Axel; Hohenfellner, Markus; Huang, William C; Espinós, Estefania Linares; Mandel, Philipp; Martinez-Salamanca, Juan I; Master, Viraj A; McKiernan, James M; Montorsi, Francesco; Novara, Giacomo; Pahernik, Sascha; Palou, Juan; Pruthi, Raj S; Rodriguez-Faba, Oscar; Russo, Paul; Scherr, Douglas S; Shariat, Shahrokh F; Spahn, Martin; Terrone, Carlo; Vergho, Daniel; Wallen, Eric M; Xylinas, Evanguelos; Zigeuner, Richard; Libertino, John A; Evans, Christopher P.
in: J UROLOGY, Jahrgang 194, Nr. 2, 08.2015, S. 304-308.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy
T2 - Multi-Institutional Analysis
AU - Nguyen, Hao G
AU - Tilki, Derya
AU - Dall'Era, Marc A
AU - Durbin-Johnson, Blythe
AU - Carballido, Joaquín A
AU - Chandrasekar, Thenappan
AU - Chromecki, Thomas
AU - Ciancio, Gaetano
AU - Daneshmand, Siamak
AU - Gontero, Paolo
AU - Gonzalez, Javier
AU - Haferkamp, Axel
AU - Hohenfellner, Markus
AU - Huang, William C
AU - Espinós, Estefania Linares
AU - Mandel, Philipp
AU - Martinez-Salamanca, Juan I
AU - Master, Viraj A
AU - McKiernan, James M
AU - Montorsi, Francesco
AU - Novara, Giacomo
AU - Pahernik, Sascha
AU - Palou, Juan
AU - Pruthi, Raj S
AU - Rodriguez-Faba, Oscar
AU - Russo, Paul
AU - Scherr, Douglas S
AU - Shariat, Shahrokh F
AU - Spahn, Martin
AU - Terrone, Carlo
AU - Vergho, Daniel
AU - Wallen, Eric M
AU - Xylinas, Evanguelos
AU - Zigeuner, Richard
AU - Libertino, John A
AU - Evans, Christopher P
N1 - Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
PY - 2015/8
Y1 - 2015/8
N2 - PURPOSE: The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass.MATERIALS AND METHODS: We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses.RESULTS: Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study.CONCLUSIONS: In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.
AB - PURPOSE: The impact of cardiopulmonary bypass in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We determine the impact of cardiopulmonary bypass on overall and cancer specific survival, as well as surgical complication rates and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without cardiopulmonary bypass.MATERIALS AND METHODS: We retrospectively analyzed 362 patients with renal cell cancer and with level III or IV tumor thrombus from 1992 to 2012 at 22 U.S. and European centers. Cox proportional hazards models were used to compare overall and cancer specific survival between patients with and without cardiopulmonary bypass. Perioperative mortality and complication rates were assessed using logistic regression analyses.RESULTS: Median overall survival was 24.6 months in noncardiopulmonary bypass cases and 26.6 months in cardiopulmonary bypass cases. Overall survival and cancer specific survival did not differ significantly in both groups on univariate analysis or when adjusting for known risk factors. On multivariate analysis no significant differences were seen in hospital length of stay, Clavien 1-4 complication rate, intraoperative or 30-day mortality and cancer specific survival. Limitations include the retrospective nature of the study.CONCLUSIONS: In our multi-institutional analysis the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality on multivariate analysis. Greater surgical complications were not independently associated with the use of cardiopulmonary bypass.
KW - Carcinoma, Renal Cell
KW - Cardiopulmonary Bypass
KW - Female
KW - Humans
KW - Kidney Neoplasms
KW - Male
KW - Middle Aged
KW - Neoplastic Cells, Circulating
KW - Nephrectomy
KW - Retrospective Studies
KW - Survival Rate
KW - Thrombectomy
KW - United States
KW - Vena Cava, Inferior
KW - Venous Thrombosis
KW - Journal Article
KW - Multicenter Study
U2 - 10.1016/j.juro.2015.02.2948
DO - 10.1016/j.juro.2015.02.2948
M3 - SCORING: Journal article
C2 - 25797392
VL - 194
SP - 304
EP - 308
JO - J UROLOGY
JF - J UROLOGY
SN - 0022-5347
IS - 2
ER -