#EAU15 - Identifying patients at high risk of perioperative death from simultaneous urological and cardiac surgery for tumors involving the inferior vena cava (IVC) - Session Highlights

MADRID, SPAIN (UroToday.com) - Tumor thrombus within the IVC, to and beyond the level of the diaphragm, has profound oncological and circulatory consequences. Surgical intervention in this group of patients remains a very high-risk procedure. The group reports on their outcomes of patients who had tumor thrombus in the IVC or right atrium requiring simultaneous urological and cardiac surgeons. This service was begun at their institution in 2007.

eauThirty-five patients were identified who qualified. Of these, 3 were deemed unsuitable for surgery. Median age was 68 years (range 31-95). Of the 32 who underwent surgery, intent was curative in 29, and cytoreductive in 3. Per Neves-Zincke classfications scheme, tumor thrombus was level IV in 22 patients, level III in 9 patients, and level II in 1 patient. Twenty-one patients had both cardiac bypass and cooling with arrest, 3 had bypass only, and 8 had neither bypass nor a cardiac arrest. Histology was clear cell in 27, adrenal carcinoma in 1, papillary RCC in 2, neuroectodermal in 1, and leiomyosarcoma in 1.

Seven of 32 (22%) were free from any complications; 14/32 (44%) had Clavien III a or above complications; and 3/32 (9%) had perioperative deaths. The group examined potential reasons why mortality existed in the 3 patients. All 3 patients who died were aged > 70 years. Five of 32 patients had preoperative INR > 2. All 3 patients who died had an elevated INR >2 preoperatively. Two of 5 patients who had preoperative INR > 2, who survived, had major complications and prolonged hospital stay. There were no deaths in the 27 patients who had normal preoperative INR. The only people aged > 70 who died (3/6) had an elevated preop INR.

The group concludes that surgical management of intra-cardiac tumors is feasible but high risk with high mortality of 9%. The patients at risk of death are those with elevated preoperative INR, which may presumably indicate physiological decompensation. As such, the group no longer recommends intra-cardiac renal tumor surgery to elderly patients with a raised INR.

Presented by Fernando A.,1 Patel S.,1 Thomas K.,1 Austin C.,2 O'Brien T.S.1 at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain

1Guys's and St. Thomas' Hospital NHS Trust, Dept. of Urology, London, 2Guys's and St. Thomas' Hospital NHS Trust, Dept. of Cardiothoracics, London

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Reported by Mohammed Haseebuddin, MD, medical writer for UroToday.com