Radical Nephrectomy and Thrombectomy Without Cardiopulmonary Bypass for Level IV Venous Thrombus Renal Cell Carcinoma: Feasibility and Technical Tips
10.22465/juo.255001180059
- Author:
Dong-Hoon LIM
1
;
Hyun Young LEE
;
Bumjin LIM
;
Jung Kwon KIM
;
Cheryn SONG
;
Dalsan YOU
;
In Gab JEONG
;
Jun Hyuk HONG
;
Bumsik HONG
;
Hanjong AHN
;
Jun Gyo GWON
;
Jungyo SUH
Author Information
1. Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Publication Type:Original Article
- From:
Journal of Urologic Oncology
2026;24(1):50-59
- CountryRepublic of Korea
- Language:English
-
Abstract:
Purpose:This study evaluated the feasibility of radical nephrectomy and thrombectomy without cardiopulmonary bypass (CPB) in patients with renal cell carcinoma (RCC) and level IV venous tumor thrombus, compared with CPB-assisted surgery.
Materials and Methods:This retrospective cohort study analyzed patients with RCC and level IV venous tumor thrombus who underwent surgery at a single center between 2014 and 2020. Feasibility of non-CPB surgery was assessed by comparing perioperative safety-related outcomes, overall survival (OS), and progression-free survival (PFS) between the non-CPB and CPB groups. Perioperative outcomes included operative time, blood loss, severe complications (Clavien-Dindo classification grade ≥III), intensive care unit (ICU) stay, and mortality. Kaplan-Meier analysis and generalized Wilcoxon tests were used to compare survival outcomes.
Results:A total of 16 patients met eligibility criteria: 5 underwent surgery without CPB, and 11 underwent CPB-assisted surgery. Median operative time was similar between the CPB and non-CPB groups (490 minutes vs. 480 minutes, p=0.650). Compared with the CPB group, blood loss was lower in the non-CPB group (4000 mL vs. 1080 mL, p=0.333). Severe complications occurred in 36.4% of CPB patients and 0% of non-CPB patients (p=0.245). ICU stay was comparable between the non-CPB and CPB groups (2 days vs. 3 days, p=0.356). OS did not differ significantly between groups (p=0.180), whereas PFS was longer in the non-CPB group (p=0.041).
Conclusions:Radical nephrectomy and thrombectomy without CPB appears feasible and may be associated with lower perioperative morbidity and blood loss without compromising oncologic outcomes. Non-CPB surgery should be considered in selected patients with level IV venous tumor thrombus when technically feasible.
