Application of cardiopulmonary bypass for resection of renal cell carcinoma and adrenocortical carcinoma extending into the right atrium

Abstract

Aim:The application of cardiopulmonary bypass to atrial involvement represents an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking. Our experiences of the management of extended thrombi into the right atrium in patients with retroperitoneal malignancy using a cardiopulmonary bypass were discussed. Methods: Data were reviewed for five patients (two men and three women; mean age, 60.4 years; range, 49-79 years) with retroperitoneal tumors displaying intracardiac tumor extension. Tumors originated in the right kidney in four patients, and in left adrenal gland in one patient. Cardiopulmonary bypass was used in all cases. Results: Mean total blood loss was 6059 mL. Mean operative time was 14.7 h. No intra-or postoperative complications due to surgical technique were encountered, and no significant bleeding occurred during incision of the inferior vena cava or after removal of tumor thrombus. The follow-up period ranged from 3 to 20 months with a mean of 12.6 months. Of the five patients, three died of metastatic diseases, one died of liver dysfunction and one remains disease free as of 18 months postoperatively. Conclusions: Our experience indicates that this procedure can be safely used for atrial involvement. Although superior long-term survival cannot be shown yet, favorable early results and a lack of perioperative complications were identified.

Surgical Treatment of Renal Cell Carcinoma With Cavoatrial Involvement: A Systematic Review of the Literature

“…Ochi and colleagues [45] used CPB alone to treat stage IV RCC tumors. Vascular control was achieved by clamping the infrarenal and intrapericardial IVC and the contralateral renal vessels, and to reduce bleeding from the hepatic veins, the hepatic artery and portal vein were controlled with the Pringle maneuver.…”

Adrenal cortical carcinoma with tumor thrombus extension into the right atrium: A case report

“…The patient was administered adjuvant treatment 7 days following surgery, which consisted of 4 g mitotane daily, in order to maintain plasma concentrations of the drug of 14–20 mg/l ( 22 ). Adjuvant mitotane therapy for ACC is controversial, since there is a limited number of randomized controlled trials, due to the low incidence of the disease.…”