AUTHOR=Ciancio Gaetano , Gonzalez Javier 

TITLE=Resection of Large Urological Tumors With or Without Inferior Vena Cava Extension in Jehova's Witnesses

JOURNAL=Frontiers in Surgery

VOLUME=Volume 7 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2020.622110

DOI=10.3389/fsurg.2020.622110

ISSN=2296-875X

ABSTRACT=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 preoperative 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 hours (range: 1.83-5.75) and 150 cc(range: 100-750), respectively. No major postoperative 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 7days (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