AUA 2018: Comparison Between Liver Derotation with Pringle Manoeuvre and Cardiopulmonary Bypass with Deep-Hypothermic Cardiac Arrest for Kidney Cancer with Mayo Level III Tumor Thrombus

San Francisco, CA ( The absolute need for cardiopulmonary bypass (CPB) and deep-hypothermic cardiac arrest (DHCA) in patients with renal cell carcinoma (RCC) and level III tumor thrombus is still debated. This study aimed to compare intra-, peri- and postoperative outcomes of patients undergoing liver de-rotation and Pringle maneuver (Group A) to patients undergoing CBP and DHCA (Group B) in patients with RCC and Mayo level III tumor thrombus. 

Between 1990 and 2017, 37 consecutive patients underwent surgery for RCC and Mayo level III tumor thrombus. Among these patients, 18 patients were included in Group A (2007-2016) and 19 in Group B (1990 - 2006). 

The results demonstrated that only Charlson Comorbidity Index and ASA scores were different among preoperative variables between the two groups. In Group A, patients presented with a worse fitness and higher comorbidity status before surgery (all p=0.01). Surgical time and units of blood transfused were inferior for patients in Group A compared to Group B (respectively, 310 vs. 510 min, 4 vs. 8 units, p=0.05). No difference between groups was recorded for cancer mortality rate (11% vs. 21%, p=0.7). 

The authors concluded that in patients with RCC and level III tumor thrombus, liver de-rotation and Pringle maneuver, in comparison to CBP and DHCA, provided shorter surgical operation time, better perioperative outcomes, and shorter length of hospital stay, despite patients having worse comorbidity and fitness preoperative status.

Presented by: Alessandro Nini, MDM Università Vita Salute San Raffaele
Co-Author: Fabio Muttin, Francesco Cianflone, Cristina Carenzi, Roberta Lucianò, Marco Catena, Elisabetta Lapenna, Alessandro Larcher, Filippo Pederzoli, Rayan Matloob, Giovanni La Croce, Renzo Colombo, Michele Paganelli, Francesco Montorsi, Claudio Doglioni, Alberto Zangrillo, Ottavio Alfieri, Patrizio Rigatti, Umberto Capitanio, Massimo Freschi, Guglielmo Cornero, Alessandro Castiglioni, Luca Aldrighetti, Roberto Bertini, Milan, Italy

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA