Renal cell carcinoma with retrohepatic inferior vena caval thrombus: placeof cardiopulmonary bypass based on a retrospective series of 10 cases.

Introduction : Renal cell carcinoma is accompanied by tumour thrombus in th e inferior vena cava (IVC) in 4 to 10% of cases. Since the; use of cardiopu lmonary bypass (CPB), surgery for extensive thrombus has been improved by r eduction of blood loss facilitating complete resection of the kidney and th rombus and possible repair of the inferior vena cava. Objectives : To analyse a retrospective series of 10 cases and to compare t he complications of CPB and conventional surgery by direct clamping. Material and Methods : From February 1985 to December 1997, 413 patients we re operated for renal cancer including 23 (5.6%) patients with tumour throm bus in the inferior vena cava. Ten bf these 23 cases of inferior vena caval thrombus were retrohepatic. Group I (5 patients) was operated under CPB an d profound hypothermia at 16 degrees C (mean duration of bypass: 30 min). G roup II (5 patients) was operated by conventional surgery (CS) (mean clamp time: 12 min). Results : No difference in terms of intraoperative complications was observ ed between the two groups, but 2 deaths occurred in group II due to respira tory decompensation, 1 and 2 weeks postoperatively. Conclusion : The level of the thrombus in the inferior vena cava determines the made of vascular management. The presence of invasion of the inferior vena cava wall is difficult to predict because of the poor sensitivity of r adiological examinations. CPB did not induce any excess morbidity in this s eries. The use of CPB in renal cancers with retrohepatic thrombus facilitat es the resection procedure and allows inferior vena cava reconstruction in a bloodless environment.