Surgery (Austin & Northern Health) - Research Publications
Permanent URI for this collection
Search Results
1 - 2 of 2
-
ItemRadical nephrectomy with caval tumor thrombectomy: An Australian experience(Canadian Urological Association, 2022)Introduction: Inferior vena cava (IVC) tumor thrombus is seen in up to 10% of renal cell carcinoma (RCC) and greatly complicates surgical management. We aimed to assess perioperative morbidity and longterm oncological outcomes after radical nephrectomy with caval tumor thrombectomy. Methods: This was a retrospective review of radical nephrectomy with caval tumor thrombectomy from 2011–2021. Continuous variables were reported as median (range). Kaplan-Meier survival curves were compared using the log-rank test. Results: We identified 22 patients; 15 (68.2%) were male and the median age was 63.5 years (34–75). There were three (13.6%) level III and eight (36.4%) level IV tumor thrombi. RCC size was 11.2 cm (2.7–21.0), with 13 (59.1%) right-sided. Nine (40.9%) patients had metastatic disease. Operative time was nine hours (5–18.8); seven (31.8) cases were performed emergently and nine (40.9%) underwent cardiopulmonary bypass. One (4.5%) patient died intraoperatively and four (18.2%) died in-hospital. Length of stay was 12.5 days (5–66) and 9 (40.9%) patients experienced Clavien-Dindo IV complications. Nineteen (86.4%) tumors were of clear-cell variant and 17 (77.3%) had positive margins. Excluding in-hospital deaths, median followup was 20 months (4–65). Five (27.8%) patients received adjuvant therapy and cancer recurrence occurred in six (33.3%). Overall survival (OS) was 66.7% (n=12) over a duration of 17 months (4–65) and recurrence-free survival (RFS) was 50% (n=9) over seven months (4–65). Time-to-recurrence and time-to-death were 9.5 months (2–19) and 13.5 months (1–33), respectively. On survival analysis, there were significant differences in OS (p=0.006) and RFS (p=0.006) with regards to metastatic status. Tumor thrombus level showed a difference in RFS only (p=0.006). Cardiopulmonary bypass was not predictive of OS (p=0.54) or RFS (p=0.82). Conclusions: Although radical nephrectomy with caval tumor thrombectomy is associated with significant morbidity and mortality, it remains an effective procedure in the treatment of advanced RCC.
-
ItemTechnique and rationale for branch-first total aortic arch repair(ELSEVIER, 2020-12)OBJECTIVE: Our objective was to describe the technique and rationale for branch-first total aortic arch repair. METHODS: Branch-first total aortic arch repair involves serial clamping, reconstruction, and reperfusion of each of the arch branches using a specially designed trifurcation graft with a side port. During this sequence, perfusion to the heart and distal organs are preserved and continuous antegrade cerebral perfusion is permitted via the trifurcation graft. The diseased aorta is excised and replaced with a Dacron graft (W.L. Gore and Associates, Newark, Del) with a perfusion side port. The trifurcation graft is anastomosed to the new proximal ascending aorta. RESULTS: The branch-first technique permits total aortic arch repair without global cerebral circulatory arrest and excessive hypothermia. It shortens distal organ and cardiac ischemic time, and reduces the opportunity for air and particulate embolization during aortic repair. CONCLUSIONS: Branch-first total aortic arch repair allows continuous antegrade cerebral perfusion and shortens distal organ and cardiac ischemic time, with unobstructed access to the full extent of the diseased aortic arch.