Abstract：
BACKGROUND: To describe the perioperative outcomes in patients treated with radical nephrectomy with cava thrombectomy at all thrombi levels using a multidisciplinary approach, with or without extracorporeal circulation (ECC), and to identify factors associated with perioperative morbidity.
METHODS: We retrospectively identified 42 patients who were diagnosed with renal cell carcinoma (RCC) and a vena cava thrombus and treated with radical nephrectomy and cava thrombectomy by a double surgical team at Lyon University Hospital from 2008 through 2021. The surgeons operated in the cardiothoracic operating theater to proceed with median sternotomy or ECC, if necessary. The primary endpoint of this study was perioperative morbidity and mortality assessed using the Clavien-Dindo scale. Complications were recorded until 90 days after surgery, and those classified as grade IIIa or higher were considered high-grade complications.
RESULTS: Overall, 32 (76%) patients required ECC. No intraoperative mortality occurred; however, two patients (5%) died within 30 days. Complications occurred within 30 days in 30 patients (72%), with severe complications observed in 10 patients (24%). No further complications occurred between 30 and 90 days. Multivariate analysis revealed that age, thrombus level, ECC, American Society of Anesthesiologists physical status, symptoms, and metastasis at presentation were not significantly associated with high-grade complications (P>0.05).
CONCLUSIONS: Multidisciplinary approach is essential and frequent use of ECC, when achieved by a trained team, may facilitate surgery, and is associated with low perioperative morbidity, especially for patients with high-level thrombi.
METHODS: IV.
METHODS: We retrospectively identified 42 patients who were diagnosed with renal cell carcinoma (RCC) and a vena cava thrombus and treated with radical nephrectomy and cava thrombectomy by a double surgical team at Lyon University Hospital from 2008 through 2021. The surgeons operated in the cardiothoracic operating theater to proceed with median sternotomy or ECC, if necessary. The primary endpoint of this study was perioperative morbidity and mortality assessed using the Clavien-Dindo scale. Complications were recorded until 90 days after surgery, and those classified as grade IIIa or higher were considered high-grade complications.
RESULTS: Overall, 32 (76%) patients required ECC. No intraoperative mortality occurred; however, two patients (5%) died within 30 days. Complications occurred within 30 days in 30 patients (72%), with severe complications observed in 10 patients (24%). No further complications occurred between 30 and 90 days. Multivariate analysis revealed that age, thrombus level, ECC, American Society of Anesthesiologists physical status, symptoms, and metastasis at presentation were not significantly associated with high-grade complications (P>0.05).
CONCLUSIONS: Multidisciplinary approach is essential and frequent use of ECC, when achieved by a trained team, may facilitate surgery, and is associated with low perioperative morbidity, especially for patients with high-level thrombi.
METHODS: IV.
摘要：
背景：为了描述使用多学科方法在所有血栓水平上接受根治性肾切除术合并静脉血栓切除术的患者的围手术期结果，有或没有体外循环(ECC)，并确定与围手术期发病率相关的因素。
方法：我们回顾性地确定了42例患者，这些患者被诊断为肾细胞癌（RCC）和腔静脉血栓，并由里昂大学医院的双重手术团队从2008年到2021年接受了根治性肾切除术和腔静脉血栓切除术。外科医生在心胸手术室进行正中胸骨切开术或ECC，如有必要。这项研究的主要终点是使用Clavien-Dindo量表评估的围手术期发病率和死亡率。记录并发症直到手术后90天，被分类为IIIa级或更高级别的患者被认为是高级别并发症.
结果：总体而言，32例（76%）患者需要ECC。没有发生术中死亡；然而，2例患者(5%)在30天内死亡.30例（72%）患者在30天内出现并发症，在10例患者中观察到严重并发症（24％）。在30至90天之间没有发生进一步的并发症。多变量分析表明，年龄，血栓水平,ECC,美国麻醉医师协会的身体状况，症状,转移与高级别并发症无显著相关性(p>0.05)。
结论：多学科方法是必不可少的，并且经常使用ECC，当一个训练有素的团队完成时，可能有助于手术，并且与低的围手术期发病率有关，尤其是高水平血栓患者。
方法：我们回顾性地确定了42例患者，这些患者被诊断为肾细胞癌（RCC）和腔静脉血栓，并由里昂大学医院的双重手术团队从2008年到2021年接受了根治性肾切除术和腔静脉血栓切除术。外科医生在心胸手术室进行正中胸骨切开术或ECC，如有必要。这项研究的主要终点是使用Clavien-Dindo量表评估的围手术期发病率和死亡率。记录并发症直到手术后90天，被分类为IIIa级或更高级别的患者被认为是高级别并发症.
结果：总体而言，32例（76%）患者需要ECC。没有发生术中死亡；然而，2例患者(5%)在30天内死亡.30例（72%）患者在30天内出现并发症，在10例患者中观察到严重并发症（24％）。在30至90天之间没有发生进一步的并发症。多变量分析表明，年龄，血栓水平,ECC,美国麻醉医师协会的身体状况，症状,转移与高级别并发症无显著相关性(p>0.05)。
结论：多学科方法是必不可少的，并且经常使用ECC，当一个训练有素的团队完成时，可能有助于手术，并且与低的围手术期发病率有关，尤其是高水平血栓患者。
