Renal Cell Carcinoma with Supradiaphragmatic Tumor Thrombus: Avoiding Sternotomy and Cardiopulmonary Bypass.
Renal Cell Carcinoma with Supradiaphragmatic Tumor Thrombus: Avoiding Sternotomy and Cardiopulmonary Bypass.
复制标题
肾细胞癌合并膈上肿瘤血栓：避免胸骨切开术和心脏搭桥术。
DOI：
10.18103/mra.v10i7.2913
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发表时间：
2022-07
期刊：
影响因子：
--
通讯作者：
Ciancio, Gaetano
中科院分区：
文献类型：
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作者：
Tabbara, Marina M;Gonzalez, Javier;Ciancio, Gaetano
肾细胞癌 (RCC) 占成人所有恶性疾病的 2-3%，并且具有浸润周围邻近结构的倾向，具有血管侵犯的生物学倾向。在高达 25% 的肾细胞癌患者中，静脉系统的这种趋向性有利于传播到肾静脉和下腔静脉 (IVC)。手术切除仍然是伴有静脉癌栓（TT）扩展的肾细胞癌的主要治疗方法，也是潜在治愈的唯一希望。较高的血栓水平与疾病的晚期阶段相关，因此生存率较低。尽管在这些肿瘤切除过程中已经成功地进行了停循环体外循环，但由于存在凝血障碍、血小板功能障碍和中枢神经系统并发症的风险，其使用仍然存在争议。通过利用肝脏动员操作，可以在不进行胸骨切开术和体外循环的情况下完成腹腔内 III 级血栓的手术切除。本综述的目的是提供这些疑难肾细胞癌伴膈上癌栓病例的手术治疗最新情况，包括描述基于移植的技术，避免胸骨切开术和体外循环（CPB），最大限度地减少术中和术后并发症。
Renal cell carcinoma (RCC) accounts for 2–3% of all malignant disease in adults and has a propensity to infiltrate the surrounding adjacent structures with a biologic predisposition for vascular invasion. This tropism for the venous system facilitates propagation into the renal vein and inferior vena cava (IVC) in up to 25% of patients with RCC. Surgical resection remains the mainstay treatment for RCC with venous tumor thrombus (TT) extension and the only hope for a potential cure. Higher thrombus levels correlate with more advanced stages of disease and thus poorer survival rates. Although CPB with circulatory arrest has been successfully performed during resection of these tumors, its use remains controversial due to the risk of coagulopathy, platelet dysfunction, and central nervous system complications. Complete intraabdominal surgical excision of level III thrombi can be achieved without sternotomy and CPB by utilizing hepatic mobilization maneuvers. The purpose of this review is to provide an update on the surgical management of these difficult cases of RCC with supradiaphragmatic tumor thrombi, including a description of transplant-based techniques that avoid sternotomy and cardiopulmonary bypass (CPB), minimizing intra- and post-operative complications.