Synchronous nephrectomy and cavoatrial tumor thrombectomy under normothermic extracorporeal circulation and beating heart

Abstract

Formation of tumor thrombus is an occasional manifestation of renal cell carcinoma (RCC). Intravascular invasion of the renal vein and thereafter the inferior vena cava (IVC) might in very rare cases extend into the cardiac chambers. The subtle course and symptoms of such cases alongside with the engagement of vital anatomical structures marks them as a diagnostic and therapeutic challenge. Aggressive surgical intervention has proven to be critical for survival rates in such cases; however total synchronous resection remains a challenge for the surgical team and a debate for the medical community. Following we report the case of a 66-year-old male who was diagnosed with a RCC of the right kidney accompanied by a tumor thrombus extending into the right atrium, after he suffered a presyncope episode. The patient underwent a radical en bloc nephrectomy and tumor thrombectomy under extracorporeal circulation with beating heart.

Infrarenal Inferior Vena Cava Cannulation During the Resection of Renal Tumors Extending Into the Right Heart – No Need for Hypothermic Total Circulatory Arrest

“…Böylece tümör eksizyonu sırasında tümör dokusu bırakma riski azalır ve inferior vena kava lümeni (özellikle hepatik ven) ile sağ atriumun optimal değerlendirilmesine olanak sağlar (9). (19). Santrifujal bir pompa kullanılarak venö-venöz bypass (IVK ve sağ atriyum kanülasyonu ile), minimal invaziv ve perkutan bypass teknikleri de literatürde bildirilmiştir (20).…”