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

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. (C) 2016 by The Society of Thoracic Surgeons