Simultaneous cardiac and renal surgery for renal and retroperitoneal tumours invading the right atrium & peri-diaphragmatic inferior vena cava: oncological outcome & long-term survival
BAUS ePoster online library. Warren H.
Jun 27, 2018; 211387
Ms. Hannah Warren
Ms. Hannah Warren
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Abstract
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Introduction: Simultaneous cardiac and renal surgery for tumours invading the inferior vena cava up to the right atrium is feasible but high risk. Given the risk and changing landscape of systemic therapy in renal cell cancer (RCC) it is important to know contemporary oncological outcomes.

Methods: Retrospective cohort study of patients referred for simultaneous cardiac and renal surgery for renal and retroperitoneal tumours. Cases identified from a prospective database collected 2007-2017. Perioperative data and oncological follow-up were extracted from electronic patient records. For patients lost to follow up, survival data was obtained from GPs. We used Kaplan-Meier curves to estimate overall and disease-free survival.

Results: 54 cases identified, 47 of whom underwent surgery. Mean age at operation 63 years (range 17-95). Neves-Zincke classification of IVC thrombus: 62% level 4 (intra-atrial), 34% level 3 (hepatic veins), 4% stages 1&2. 12/47 had radiological evidence of metastasis at presentation. 3/47 patients (6%) died in the peri-operative period and were excluded from further analysis. Histology confirmed 33 clear cell RCCs, six papillary cell RCCs and five non-RCCs. Median post-operative survival was 30 months (interquartile range 14.9 - upper quartile not reached). Of the 12 who underwent cytoreductive surgery median post-operative survival was 16.1 versus 32.7 months for those treated with curative intent. Disease free survival was 10.4 months (IQR 5.9 - 38.8) in those treated with curative intent.

Conclusions: Median postoperative survival of 2.5 years and relief of circulatory symptoms appears to justify surgery in patients with renal and retroperitoneal tumours invading the heart.
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