Cardiopulmonary bypass with brain perfusion for renal cell carcinoma with caval thrombosis

Table 1 Details of the two groups

Patients and tumors characteristics	sCPB	CPB+BP	P
Age (yr)	64.0 ± 9.2	66.2 ± 10.2	NS
Gender
Males	7/9 (77.8%)	9/15 (60%)	NS
Females	2/9 (22.2%)	6/15 (40%)
Pre-operative ejection fraction	59.7% ± 0.8%	57.6% ± 4.6%	NS
Comorbidity
Charlson score 0	2/9 (22.2%)	6/15 (40%)	NS
Charlson score ≥ 1	7/9 (77.8%)	9/15 (60%)
Tumor side
Right	7/9 (77.8%)	10/15 (66.7%)	NS
Left	2/9 (22.2%)	5/15 (33.3%)
Tumor diameter (cm)	9.6 ± 2.5	9.6 ± 2.9	NS
Level of thrombosis
3	5/9 (56.6%)	8/15 (53.3%)	NS
4	4/9 (44.4%)	7/15 (46.6%)
Histology
Clear Cell renal carcinoma	7/9 (77.8%)	13/15 (86.6%)	NS
Other	2/9 (22.2%)	2/15 (13.3%)
Infiltration of perirenal tissues	7 (77.8%)	10 (66.7%)	NS
Infiltration of venous wall	3 (33.3%)	4 (26.6%)	NS
N+	1 (11.1%)	2 (13.3%)	NS
M+	2 (22.2%)	5 (33.3%)	NS

NS: Not significant; CPB: Cardiopulmonary by-pass.

Table 2 Complications observed in the 2 groups, according to the Clavien-Dindo’s scale

Clavien grade	sCPB	CPB + BP
1	4 acute renal failures	5 acute renal failures
2	3 transfusions	7 transfusions
	3 atrial fibrillations	7 atrial fibrillations
3a	1 sternal wound dehiscence
3b	1 bleeding requiring re-laparotomy	1 bleeding requiring re-laparotomy
		1 ligature of the contralateral ureter, requiring ureteral stenting
4a	2 = respiratory failures	1 brain stroke
		1 pulmonary embolism
		3 respiratory failures
4b	-	1 multi-organ failure
5	1 (1st post-operative day)	2 (3rd and 25th post-operative day)

CPB: Cardiopulmonary by-pass. NS: not significant.

Table 3 Comparison in terms of intra- and peri-operative characteristics between the 2 groups

Intra- and post-operative variables	sCPB	CPB+BP	P
CPB time (min)	92.5 ± 35.7	76.1 ± 18.5	NS
Aortic Clamp time (min)	30.8 ± 15.8	26.5 ± 19.6	NS
Circulatory arrest time (min)	13.7 ± 8.9	17.4 ± 5.3	NS
Minimum temperature (°C)	26.4 ± 2.5	29.9 ± 1.9	0.001
Intraoperative blood units transfused (no.)	12 (4-12)	13.2 (6-20)	NS
ICU stay (in days)	2 (2-2)	2.7 (1-3)	NS
Hospital stay (in days)	27 (22-57)	21 (10-25)	NS
Post-operative Cr > 2 mg/dL	4/9 (44.4%)	5/15 (33.3%)	NS
Post-operative GOT or GPT > 50 U/L	4/9 (44.4%)	8/15 (53.3%)	NS
Post-operative bleeding	5/9 (55.6%)	8/15 (53.3%)	NS
Peri-operative mortality	1/11 (11.1%)	2/15 (13.3%)	NS

CPB: Cardiopulmonary by-pass. NS: not significant; GOT: Glutamic-oxalacetic transaminase; GPT: Glutamic-pyruvic transaminase.