Cirugía con circulación extracorpórea e hipotermia en tumores con extensión a vena cava: 20 años de experiencia de la Clínica Universitaria de Navarra

Resumen Objetivos Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia, parada cardiaca y exanguinotransfusión (CEC-H-PC-E) para que junto con la resección tumoral se resecara el trombo tumoral en su tota...

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Published in:	Actas urologicas españolas Vol. 32; no. 4; pp. 396 - 405
Main Authors:	Rábago, G, Rioja Zuazu, J, Rodríguez-Rubio Cortadellas, F.I, Zudaire Bergera, J.J, Saiz Sansi, A, Rosell Costa, D, Robles García, J.E, Berián Polo, J.M
Format:	Journal Article
Language:	Portuguese Spanish
Published:	Elsevier Espana 2008 Asociación Española de Urología
Subjects:	Cava thrombus Circulación extracorpórea Extracorporeal circulation Renal tumor Trombo en cava Tumor renal Urology Trombo en cava Circulación extracorpórea Cava thrombus Tumor renal Renal tumor Extracorporeal circulation
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Abstract	Resumen Objetivos Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia, parada cardiaca y exanguinotransfusión (CEC-H-PC-E) para que junto con la resección tumoral se resecara el trombo tumoral en su totalidad Material y Métodos: Entre los años 1985 y 2005 se trataron 28 tumores retroperitoneales: 25 tumores renales, un tumor de Wilms, un rabdomiosarcoma paratesticular y un feocromocitoma. Todos ellos presentaban extensión en forma de trombo en la vena cava por encima de las venas suprahepáticas. A todos se les realizó CEC-H-PC-E para la extracción del trombo tumoral. Se realiza una descripción de la serie así como un análisis de la supervivencia de Kaplan-Meier Resultados Se presentaron complicaciones quirúrgicas en 10 pacientes (35%), con una mortalidad quirúrgica de dos pacientes (7%): intraoperatoria por embolismo pulmonar masivo en un paciente y al 4º día postquirúrgico por embolismo pulmonar. La supervivencia actuarial global fue de 29,1±10% a tres años y 17,5±8% a cinco años. Analizando por separado aquellos que tienen que no presentan lesiones metastásica ni ganglionares en el diagnóstico su supervivencia fue a tres años del 50,9±16,3% y del 38,2±16% a cinco años. Mientras aquellos que presentan algún tipo de lesión a distancia presentaron una supervivencia a tres y cinco años de 20,8±12% y 10,4±9% respectivamente Conclusiones La utilización de técnicas quirúrgicas con CEC-H-PC-E en patologías tumorales que se asocian a trombo en vena cava, esta justificada y su utilización no empeora la supervivencia; está indicada por sus resultados, permitiendo una resección tumoral de una manera segura y reproductible
AbstractList	Objetivo: Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia, parada cardiaca y exanguinotransfusión (CEC-H-PC-E) para que junto con la resección tumoral se resecara el trombo tumoral en su totalidad. Material y Métodos: Entre los años 1985 y 2005 se trataron 28 tumores retroperitoneales: 25 tumores renales, un tumor de Wilms, un rabdomiosarcoma paratesticular y un feocromocitoma. Todos ellos presentaban extensión en forma de trombo en la vena cava por encima de las venas suprahepáticas. A todos se les realizó CEC-H-PC-E para la extracción del trombo tumoral. Se realiza una descripción de la serie así como un análisis de la supervivencia de Kaplan-Meier. Resultados: Se presentaron complicaciones quirúrgicas en 10 pacientes (35%), con una mortalidad quirúrgica de dos pacientes (7%): intraoperatoria por embolismo pulmonar masivo en un paciente y al 4º día postquirúrgico por embolismo pulmonar. La supervivencia actuarial global fue de 29,1±10% a tres años y 17,5±8% a cinco años. Analizando por separado aquellos que tienen que no presentan lesiones metastásica ni ganglionares en el diagnóstico su supervivencia fue a tres años del 50,9±16,3% y del 38,2±16% a cinco años. Mientras aquellos que presentan algún tipo de lesión a distancia presentaron una supervivencia a tres y cinco años de 20,8±12% y 10,4±9% respectivamente. Conclusiones: La utilización de técnicas quirúrgicas con CEC-H-PC-E en patologías tumorales que se asocian a trombo en vena cava, esta justificada y su utilización no empeora la supervivencia; está indicada por sus resultados, permitiendo una resección tumoral de una manera segura y reproductible. Resumen Objetivos Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia, parada cardiaca y exanguinotransfusión (CEC-H-PC-E) para que junto con la resección tumoral se resecara el trombo tumoral en su totalidad Material y Métodos: Entre los años 1985 y 2005 se trataron 28 tumores retroperitoneales: 25 tumores renales, un tumor de Wilms, un rabdomiosarcoma paratesticular y un feocromocitoma. Todos ellos presentaban extensión en forma de trombo en la vena cava por encima de las venas suprahepáticas. A todos se les realizó CEC-H-PC-E para la extracción del trombo tumoral. Se realiza una descripción de la serie así como un análisis de la supervivencia de Kaplan-Meier Resultados Se presentaron complicaciones quirúrgicas en 10 pacientes (35%), con una mortalidad quirúrgica de dos pacientes (7%): intraoperatoria por embolismo pulmonar masivo en un paciente y al 4º día postquirúrgico por embolismo pulmonar. La supervivencia actuarial global fue de 29,1±10% a tres años y 17,5±8% a cinco años. Analizando por separado aquellos que tienen que no presentan lesiones metastásica ni ganglionares en el diagnóstico su supervivencia fue a tres años del 50,9±16,3% y del 38,2±16% a cinco años. Mientras aquellos que presentan algún tipo de lesión a distancia presentaron una supervivencia a tres y cinco años de 20,8±12% y 10,4±9% respectivamente Conclusiones La utilización de técnicas quirúrgicas con CEC-H-PC-E en patologías tumorales que se asocian a trombo en vena cava, esta justificada y su utilización no empeora la supervivencia; está indicada por sus resultados, permitiendo una resección tumoral de una manera segura y reproductible Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia, parada cardiaca y exanguinotransfusión (CEC-H-PC-E) para que junto con la resección tumoral se resecara el trombo tumoral en su totalidad Entre los años 1985 y 2005 se trataron 28 tumores retroperitoneales: 25 tumores renales, un tumor de Wilms, un rabdomiosarcoma paratesticular y un feocromocitoma. Todos ellos presentaban extensión en forma de trombo en la vena cava por encima de las venas suprahepáticas. A todos se les realizó CEC-H-PC-E para la extracción del trombo tumoral. Se realiza una descripción de la serie así como un análisis de la supervivencia de Kaplan-Meier Se presentaron complicaciones quirúrgicas en 10 pacientes (35%), con una mortalidad quirúrgica de dos pacientes (7%): intraoperatoria por embolismo pulmonar masivo en un paciente y al 4º día postquirúrgico por embolismo pulmonar. La supervivencia actuarial global fue de 29,1±10% a tres años y 17,5±8% a cinco años. Analizando por separado aquellos que tienen que no presentan lesiones metastásica ni ganglionares en el diagnóstico su supervivencia fue a tres años del 50,9±16,3% y del 38,2±16% a cinco años. Mientras aquellos que presentan algún tipo de lesión a distancia presentaron una supervivencia a tres y cinco años de 20,8±12% y 10,4±9% respectivamente La utilización de técnicas quirúrgicas con CEC-H-PC-E en patologías tumorales que se asocian a trombo en vena cava, esta justificada y su utilización no empeora la supervivencia; está indicada por sus resultados, permitiendo una resección tumoral de una manera segura y reproductible Extracorporeal circulation and hypothermy surgery in tumors with vena cava extension: 20 years experience at the university clinic of navarra We present our 20 years experience treating patients with vena cava extension in whom an extracorporeal circulation, hypothermia, cardio circulatory arrest (ECC-H-CCA) in order to perform, together with a tumoral resection, a thrombus resection From 1985 to 2005 a total of 28 retroperitoneal tumor were treated: 25 renal cancers, a Wilms tumor, a paratesticular rabdomiosarcoma, and a pheocromocitoma. All of them had an extension by means of thrombus above the suprahepatics veins. All of them were treated by means of ECC-H-CCA for thrombus extraction. A descriptive study of the serie is performed as well as a Kaplan Meyer survival study Surgical complications were present within 10 patients (35%), with a surgical mortality of two patients (7%): one intra-operatively because a massive embolism of the lungs and the other because of a lung embolism on the 4th post-operative day. Global actuarial survival was 29.1±10% at three years and 17,5±8% at five years. Analyzing only who do not have metastatic lesions, nor lymph nodes at diagnosis their three year survival was 50,9±16,3% and 32,2±16% at five years. Mean while those who have any metastatic lesion at diagnosis their three and five years survival was 20,8±12% and 10,4±9% respectively The employ of surgical techniques with ECC-H-CCA with in oncological pathology associated with vena cava thrombus is justified and its employment does not worsen the survival; it is indicated because its results, allowing a complete tumoral resection in a safe and reproducible fashion. Keywords: Renal tumor. Cava thrombus. Extracorporeal circulation
Author	Rodríguez-Rubio Cortadellas, F.I Robles García, J.E Berián Polo, J.M Saiz Sansi, A Rosell Costa, D Rábago, G Zudaire Bergera, J.J Rioja Zuazu, J
AuthorAffiliation	Universidad de Navarra Hospital Universitario Puerto Real Universidad Navarra
AuthorAffiliation_xml	– name: Universidad Navarra – name: Universidad de Navarra – name: Hospital Universitario Puerto Real
Author_xml	– sequence: 1 fullname: Rábago, G – sequence: 2 fullname: Rioja Zuazu, J – sequence: 3 fullname: Rodríguez-Rubio Cortadellas, F.I – sequence: 4 fullname: Zudaire Bergera, J.J – sequence: 5 fullname: Saiz Sansi, A – sequence: 6 fullname: Rosell Costa, D – sequence: 7 fullname: Robles García, J.E – sequence: 8 fullname: Berián Polo, J.M
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Keywords	Trombo en cava Circulación extracorpórea Cava thrombus Tumor renal Renal tumor Extracorporeal circulation
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Snippet	Resumen Objetivos Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea,... Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia, parada... Objetivo: Presentamos 20 años de experiencia en pacientes con tumores con extensión a vena cava en los que se realizaron circulación extracorpórea, hipotermia,...
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SubjectTerms	Cava thrombus Circulación extracorpórea Extracorporeal circulation Renal tumor Trombo en cava Tumor renal Urology
Title	Cirugía con circulación extracorpórea e hipotermia en tumores con extensión a vena cava: 20 años de experiencia de la Clínica Universitaria de Navarra
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