Resection of Intraabdominal Tumors With Cavoatrial Extension Using Deep Hypothermic Circulatory Arrest

Abstract

Background: Intraabdominal malignancies with cavoatrial extension can be resected using cardiopulmonary bypass and deep hypothermic circulatory arrest (DHCA).

Methods: Twenty-five consecutive patients underwent resection of intraabdominal tumor with cavoatrial thrombectomy using DHCA at a single tertiary center. Recurrence-free survival, cancer-specific survival, and overall survival were estimated using Kaplan-Meier analysis.

Results: All patients had renal artery embolization preoperatively. Procedures were performed through a median sternotomy with bilateral subcostal incision. Tumors were resected under DHCA. Mean age was 57 ± 14 years, 60% were hypertensive, 20% were diabetic, 16% had coronary disease, 44% were smokers, 16% had neoplastic pulmonary embolism, and the mean creatinine was 1.4 ± 0.75 mg/dL. Mean cardiopulmonary bypass, cross-clamp, and DHCA times were 137.4 ± 25.5, 33.2 ± 14.7, and 26.3 ± 13.8 minutes, respectively. R0 resection was achieved in 76% and R1 resection in 4%. Metastatic disease was present in 20%, and 8% had N1 disease. The pathologic diagnosis was renal cell carcinoma in 20 of 25 patients (80%) and adrenocortical carcinoma, Wilms tumor, adrenal melanoma, and spinal chordoma in 1 patient each. Operative mortality was 8%. Twelve percent needed hemodialysis, 8% had pneumonia, 4% stroke, and 8% required reexploration for bleeding. Mean follow-up time was 32.5 months. At last follow-up, 56% had died of disease and 28% were alive, 16% without evidence of disease. Actuarial 5-year survival for the entire cohort was 36%.

Conclusions: Intraabdominal malignancies with cavoatrial extension can be safely resected. Excellent local tumor control can be anticipated. Long-term surveillance is necessary to detect recurrence.