Removal of Renal Cell Carcinoma Extending into the Right Atrium using Cardiopulmonary Bypass, Profound Hypothermia and Circulatory Arrest

Abstract

An operation is indicated in patients with renal cancer growing into the inferior vena cava and right atrium because the tumor in the right atrium presents an immediate risk to life if acute obstruction of the tricuspid valve or pulmonary emboli occur. In addition, patients treated by such an operation may enjoy reasonable survivals. We believe that the best technique for operative management includes cardiopulmonary bypass, profound hypothermia and total circulatory arrest. Although perhaps seemingly complicated, it is the only technique that simplifies the operative dissection and permits as complete removal as possible of the cancer without the risk of tumor embolization or uncontrollable hemorrhage.

Surgical Management of Retroperitoneal Tumors with Vena Cavai Thrombus in the Inferior Cava Using Cardiopulmonary Bypass, Arrested Circulation and Profound Hypothermia

“…To resolve these problems Marshall et al [8] described a car diopulmonary bypass in 1970, but initial results were poor with lumbar or hepatic venous bleeding continuing to be the major problem. The next step in improving this technique was the incorporation of hypothermia, cardiac arrest and temporary exsanguination achieved by the car diopulmonary bypass [9,10]. Controlled dissection of the vena cava in a virtually blood-free area was achieved with the consequent theoretical reduction of the risks of cellu lar dispersion and pulmonary embolism.…”

Use of Dynamic Two-Dimensional Transesophageal Echocardiography for Renal Cell Carcinoma with Cavoatrial Tumor Thrombus

“…Renal cell carcinoma extends to the level of the right atrium in approximately 1% of the cases [1][2][3]9], Al though 50-75% of the patients with IVC tumor thrombus are asymptomatic, atrial thrombus may produce sudden death from acute tricuspid valve obstruction or pulmo nary embolism. Right-sided congestive heart failure and atrial arrhythmias may also occur [7,[9][10][11], Precise preoperative definition of the cephalad extent of tumor thrombus is essential for planning surgical exci sion.…”

“…Renal cell carcinoma with inferior vena caval tumor thrombus extending to the level of the right atrium occurs in about 1% of all cases [1][2][3]. In the absence of distant metastases, positive lymph nodes, or perinephric fat inva sion, surgical excision of the renal tumor and its thrombus is associated with a 5-year survival of 20-50% [4][5][6][7], Precise preoperative determination of the cephalad extent of the tumor thrombus is essential for planning sur gical excision.…”

Surgical treatment of renal cell carcinoma with extension into the vena cava

“…The initial approach to the vena cava and the technical features of the bypass operation have already been described in detail [6,7,9,11,12,14,19,22]. In brief, either a thoracoabdominal or midline approach with median sternotomy provides good exposure.…”