Does Cardiopulmonary Bypass Affect Outcomes in Nephrectomy with Level III/IV Caval Thrombectomy for Renal Cell Carcinoma?

Radical nephrectomy with inferior vena cava (IVC) thrombectomy is a technically complex procedure. Cardiopulmonary bypass (CPB) is frequently employed for managing high-level thrombi, yet its impact on surgical outcomes remains uncertain. This study evaluated the outcomes of radical nephrectomy with level III/IV thrombectomy with or without CPB. We retrospectively reviewed records of patients with renal cell carcinoma and level III/IV (Mayo classification) thrombi who underwent open radical nephrectomy and IVC thrombectomy at our center between January 2000 and December 2023. Perioperative and survival outcomes were compared between patients in the CPB and non-CPB groups. Multivariable regression identified clinical factors associated with all-grade complications and survival. Primary and secondary outcomes were 90-day complications and overall survival. Fifty-seven patients were included: 30 (53%) in the CPB group and 27 (47%) in the non-CPB group. Within 90 days, overall complication and mortality rates were 49% and 10.5%; no statistically significant differences were observed between groups. In multivariable models, CPB was not independently associated with 90-day complications (odds ratio [OR] 0.55, 95% CI 0.13-2.12, <i>p</i> = 0.4) or overall survival (hazard ratio [HR] 1.34, 95% CI 0.65-2.78, <i>p</i> = 0.41). In our cohort, we did not find CPB use to independently influence perioperative complications or survival outcomes in radical nephrectomy with level III/IV IVC thrombectomy.