Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses
Background: Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood trans...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-12-01
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| Series: | Frontiers in Surgery |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2020.622110/full |
| _version_ | 1831740669457072128 |
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| author | Gaetano Ciancio Gaetano Ciancio Gaetano Ciancio Javier Gonzalez |
| author_facet | Gaetano Ciancio Gaetano Ciancio Gaetano Ciancio Javier Gonzalez |
| author_sort | Gaetano Ciancio |
| collection | DOAJ |
| description | Background: Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood transfusion. A transplant-based (TB) approach to these tumors in JWs would result a safe surgical method, providing limited blood loss and perioperative complications. We report our experience using a TB surgical approach in JW harboring large adrenal/renal tumors with/without tumor thrombus trying to determine its usefulness in this setting.Patients and Methods: From 2003 to 2011, 7 patients underwent resection of renal/adrenal tumors with/without tumor thrombus in the IVC by means of a TB approach. Thrombus level was renal (n = 2), retrohepatic (n = 1), and suprahepatic (n = 1). The remaining 3 patients did not present thrombus. No pre-operative optimization or cell-saver were used. Estimated blood loss, perioperative complications (Clavien-Dindo and cause), hemoglobin/hematocrit loss, and length of stay were considered main outcomes.Results: The intervention was successfully completed without transfusion in all cases. Operative time and blood loss were 2.5 h (range: 1.83–5.75) and 150 cc (range: 100–750), respectively. No major post-operative complications were registered. However, minor complications were detected in 57% of the patients included. Median hemoglobin loss was 1.13 mg/dL, which translated a median hematocrit loss of 2.3%. Patients were discharged in a median of 7 days (range 5–20).Conclusions: A TB-surgical approach provides enhanced retroperitoneal exposure and optimal vascular control, thus limiting operative blood loss or major complication development, thus resulting useful in JWs. |
| first_indexed | 2024-12-21T14:02:39Z |
| format | Article |
| id | doaj.art-d6a59d41155948ddb5085c31edf90fbd |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-21T14:02:39Z |
| publishDate | 2020-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Surgery |
| spelling | doaj.art-d6a59d41155948ddb5085c31edf90fbd2022-12-21T19:01:20ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2020-12-01710.3389/fsurg.2020.622110622110Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's WitnessesGaetano Ciancio0Gaetano Ciancio1Gaetano Ciancio2Javier Gonzalez3Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United StatesDepartment of Urology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United StatesMiami Transplant Institute, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, United StatesDepartment of Urology, Hospital General Universitario Gregorio Marañón, Madrid, SpainBackground: Renal and adrenal tumors with/without tumor thrombus in the inferior vena cava (IVC) pose a challenge to the surgeon due to the potential for massive hemorrhage and tumor thromboemboli. The situation would be more critical for Jehovah's Witness (JW) patients which refuse blood transfusion. A transplant-based (TB) approach to these tumors in JWs would result a safe surgical method, providing limited blood loss and perioperative complications. We report our experience using a TB surgical approach in JW harboring large adrenal/renal tumors with/without tumor thrombus trying to determine its usefulness in this setting.Patients and Methods: From 2003 to 2011, 7 patients underwent resection of renal/adrenal tumors with/without tumor thrombus in the IVC by means of a TB approach. Thrombus level was renal (n = 2), retrohepatic (n = 1), and suprahepatic (n = 1). The remaining 3 patients did not present thrombus. No pre-operative optimization or cell-saver were used. Estimated blood loss, perioperative complications (Clavien-Dindo and cause), hemoglobin/hematocrit loss, and length of stay were considered main outcomes.Results: The intervention was successfully completed without transfusion in all cases. Operative time and blood loss were 2.5 h (range: 1.83–5.75) and 150 cc (range: 100–750), respectively. No major post-operative complications were registered. However, minor complications were detected in 57% of the patients included. Median hemoglobin loss was 1.13 mg/dL, which translated a median hematocrit loss of 2.3%. Patients were discharged in a median of 7 days (range 5–20).Conclusions: A TB-surgical approach provides enhanced retroperitoneal exposure and optimal vascular control, thus limiting operative blood loss or major complication development, thus resulting useful in JWs.https://www.frontiersin.org/articles/10.3389/fsurg.2020.622110/fullrenal cell carcinomaadrenal carcinomatumor thrombustransplant-based approachestimated blood losstransfusion |
| spellingShingle | Gaetano Ciancio Gaetano Ciancio Gaetano Ciancio Javier Gonzalez Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses Frontiers in Surgery renal cell carcinoma adrenal carcinoma tumor thrombus transplant-based approach estimated blood loss transfusion |
| title | Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses |
| title_full | Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses |
| title_fullStr | Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses |
| title_full_unstemmed | Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses |
| title_short | Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses |
| title_sort | resection of large urological tumors with or without inferior vena cava extension in jehova s witnesses |
| topic | renal cell carcinoma adrenal carcinoma tumor thrombus transplant-based approach estimated blood loss transfusion |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2020.622110/full |
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