From the Research
The most frequent significant complication of nephrectomy with removal of tumor thrombus from the right atrium under hypothermia and circulatory arrest is neurological dysfunction, as evidenced by the potential for temporary or permanent cognitive impairment, stroke, or seizures 1, 2, 3. This complication is a major concern due to the sensitivity of the brain to oxygen deprivation, even when the body is cooled to reduce metabolic demands. The risk of neurological dysfunction increases with longer circulatory arrest times, particularly when exceeding 30-45 minutes.
Key Factors Contributing to Neurological Dysfunction
- Longer circulatory arrest times
- Inadequate cooling before arrest
- Inadequate rewarming protocols
- Lack of selective cerebral perfusion techniques
Management Strategies to Minimize Risk
- Limit circulatory arrest time
- Employ selective cerebral perfusion techniques when possible
- Ensure adequate cooling before arrest
- Follow strict protocols for rewarming
- Careful neurological monitoring during the postoperative period
Recent Studies and Findings
A study from 2014 3 proposed a surgical maneuver enabling selective arch perfusion, allowing for milder hypothermia and liberal interval of circulatory arrest, which may help minimize the risk of neurological dysfunction. Another study from 2009 4 highlighted the importance of strict attention to surgical principles to decrease the risk of intraoperative thrombus embolization, which can also contribute to neurological complications.
Clinical Implications
In clinical practice, it is essential to carefully weigh the risks and benefits of nephrectomy with removal of tumor thrombus from the right atrium under hypothermia and circulatory arrest, and to consider alternative approaches, such as neoadjuvant targeted therapy 5, to minimize the risk of neurological dysfunction and other complications.