Deep hypothermic circulatory arrest for resection of renal tumor in the inferior vena cava - Beneficial or deleterious?

Background The use of deep hypothermic circulatory arrest (CA) during resection of renal tumors with caval extension is limited in many institutes because of possible adverse effects on immune or platelet function. The present study examined whether routine use of CA implied a negative impact on prognosis. Methods and Results Thirty-six cases of renal tumor with caval extension were retrospectively reviewed (age range, 40-82 years; follow-up, 5 months to 23 years). The mean extension level (Novick classification) in the single clamp (SC) group (n=13), partial bypass (PB) group (n=8), and CA group (n=15) was 1.4, 1.8, and 3.0, respectively. There was 1 operative death (intraoperative pulmonary embolism: PB group) and 1 hospital death (pulmonary embolism of residual tumor: SC group). Volumes of bleeding and transfusion were comparable in the PB and CA groups. Although the level of tumor extension was significantly higher and operation time significantly longer in the CA group than in the other 2 groups (p<0.0001 and p=0.0003), the rate of local recurrence and 5-year survival were comparable among the 3 groups (overall 5-year survival rate 53.1%). Conclusions The benefits and safety of tumor resection under CA might exceed its disadvantages.