Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis

Hao G. Nguyen, Derya Tilki, Marc Dall'Era, Blythe Durbin-Johnson, Joaquín A. Carballido, Thenappan Chandrasekar, Thomas Chromecki, Gaetano Ciancio, Siamak Daneshmand, Paolo Gontero, Javier Gonzalez, Axel Haferkamp, Markus Hohenfellner, William C. Huang, Estefania Linares Espinós, Philipp Mandel, Juan I. Martinez-Salamanca, Viraj A. Master, James M. McKiernan, Francesco MontorsiGiacomo Novara, Sascha Pahernik, Juan Palou, Raj S. Pruthi, Oscar Rodriguez-Faba, Paul Russo, Douglas S. Scherr, Shahrokh F. Shariat, Martin Spahn, Carlo Terrone, Daniel Vergho, Eric M. Wallen, Evanguelos Xylinas, Richard Zigeuner, John A. Libertino, Christopher P Evans

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)304-308
Number of pages5
JournalJournal of Urology
Volume194
Issue number2
DOIs
StatePublished - Aug 1 2015

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Thrombectomy
Inferior Vena Cava
Nephrectomy
Cardiopulmonary Bypass
Survival
Neoplasms
Mortality
Length of Stay
Multivariate Analysis
Intraoperative Complications
Renal Cell Carcinoma
Proportional Hazards Models
Thrombosis
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • carcinoma
  • cardiopulmonary bypass
  • inferior
  • intraoperative complications
  • renal cell
  • survival
  • vena cava

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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; 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.; Linares Espinós, Estefania; 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: Journal of Urology, Vol. 194, No. 2, 01.08.2015, p. 304-308.

Research output: Contribution to journalArticle

Nguyen, HG, Tilki, D, Dall'Era, M, Durbin-Johnson, B, Carballido, JA, Chandrasekar, T, Chromecki, T, Ciancio, G, Daneshmand, S, Gontero, P, Gonzalez, J, Haferkamp, A, Hohenfellner, M, Huang, WC, Linares Espinós, E, Mandel, P, Martinez-Salamanca, JI, Master, VA, McKiernan, JM, Montorsi, F, Novara, G, Pahernik, S, Palou, J, Pruthi, RS, Rodriguez-Faba, O, Russo, P, Scherr, DS, Shariat, SF, Spahn, M, Terrone, C, Vergho, D, Wallen, EM, Xylinas, E, Zigeuner, R, Libertino, JA & Evans, CP 2015, 'Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy: Multi-Institutional Analysis', Journal of Urology, vol. 194, no. 2, pp. 304-308. https://doi.org/10.1016/j.juro.2015.02.2948
Nguyen, Hao G. ; Tilki, Derya ; Dall'Era, Marc ; 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. ; Linares Espinós, Estefania ; 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. / Cardiopulmonary Bypass has No Significant Impact on Survival in Patients Undergoing Nephrectomy and Level III-IV Inferior Vena Cava Thrombectomy : Multi-Institutional Analysis. In: Journal of Urology. 2015 ; Vol. 194, No. 2. pp. 304-308.
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abstract = "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.",
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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

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 - Linares Espinós, Estefania

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

PY - 2015/8/1

Y1 - 2015/8/1

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

KW - cardiopulmonary bypass

KW - inferior

KW - intraoperative complications

KW - renal cell

KW - survival

KW - vena cava

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