Radical nephrectomy and intracaval thrombectomy for advanced renal cancer with extensive inferior vena cava involvement utilising cardiopulmonary bypass and hypothermic circulatory arrest: Is it worthwhile?

Introduction: Renal cancer is unique for many reasons. One reason is that renal cell carcinoma can grow directly into the drainage veins of the kidney, which enter the inferior vena cava leading to the heart. This growth of tumor cells into the veins is called a tumor thrombus and is a locally aggressive renal cancer. The present article informs about the experience of our cardiac surgery department together with the transplant surgery department in successful surgical removal of a kidney with tumor, with invasion into the inferior vena cava, right atrium of the heart and pulmonary artery in two case reports. Case Reports: A 32 years old female without significant history, with suddenly evolving dyspnea was urgently admitted to hospital. Her condition was suspected to be caused by pulmonary artery embolisation. The diagnosis was confirmed by CT scan which revealed unknown tumor mass of the right kidney and tumor embolisation in inferior vena cava and pulmonary artery. The patient was urgently operated by a vascular surgeon and cardiothoracic surgeon. They successfully performed left radical nephrectomy and total thromboembolectomy of the tumorous masses from vena cava inferior and pulmonary artery. The postoperative course was without complications, postoperative CT revealed no residual masses, and the patient was discharged in a good condition from the hospital. A 58 years old male with arterial hypertension suffered from orchiepididymitis. CT scan showed a tumor of the left kidney with propagation of tumorous masses to inferior vena cava and pulmonary artery. In elective surgery the vascular surgeon and cardiothoracic surgeon successfully performed left radical nephrectomy with total thromboembolectomy of the tumorous masses from inferior vena cava and pulmonary artery. After surgery a temporary paralytic ileus and an episode of atrial fibrillation occurred. Both are common postoperative complications related to the given surgical procedure. Follow-up CT scan showed no residual tumor or thrombus in inferior vena cava and pulmonary artery. Echocardiography revealed persistent dilation of right compartments of the heart with good systolic functions of both ventricles. The patient was discharged from hospital in a good condition. Conclusion: Surgical removal of renal tumor and tumor thrombus – radical nephrectomy with tumor thrombectomy – can be a curative treatment and can ensure long-term survival of the patient. Depending on the extent of the tumor thrombus, these operations can be performed in different ways – mini-invasive, robotic or open. When open surgery is used, it is possible to perform the procedure with or without extracorporeal circulation (cardiopulmonary bypass – CPB) depending on the extent of the disease.

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Risk factors for acute kidney injury after unilateral radical nephrectomy and inferior vena cava thrombectomy under cardiopulmonary bypass: a retrospective study

10.21203/rs.3.rs-381926/v1 ◽

2021 ◽

Author(s):

Qi Zhang ◽

Ming Li ◽

Dongmei Fu ◽

Dongxin Wang ◽

Shiqi Diao

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Retrospective Study ◽

Cardiopulmonary Bypass ◽

Inferior Vena Cava ◽

Radical Nephrectomy ◽

Inferior Vena ◽

Vena Cava ◽

Kidney Injury ◽

Postoperative Aki

Abstract In patients with renal cell carcinoma (RCC) and cancer-related thrombosis in the inferior vena cava (IVC) or right atrium (AT), it is still unknown whether nephrectomy, anesthesia, and surgical trauma can cause postoperative acute kidney injury (AKI) and what are the risk factors for AKI. To examine the incidence and risk factors of postoperative AKI in patients who underwent unilateral radical nephrectomy and cardiopulmonary bypass (CPB)-assisted thrombectomy in the IVC and/or atrial AT due to RCC complicated with cancer-associated thrombosis. This retrospective study included patients who underwent unilateral radical nephrectomy and CPB-assisted thrombectomy in the inferior vena cava and/or atrial pulmonary artery due to RCC, under general anesthesia, from December 2011 to June 2015, at Peking University First Hospital. Among 31 patients, 15 (48.4%) had postoperative AKI. Compared with the non-AKI group (n = 16), patients in the AKI group (n = 15) were older (59.0 ± 8.7 vs. 48.5 ± 12.9 years, P = 0.012) had smaller intraoperative urine volume (1225 ± 639 vs. 1685 ± 597 mL, P = 0.048). There were no differences in preoperative creatinine clearance. Age (OR = 1.10, 95%CI: 1.02–1.20, P = 0.020) was independently associated with AKI occurrence. The patients undergoing unilateral radical nephrectomy and CPB-assisted IVC thrombectomy have a high rate of AKI. Older ones are at a higher risk of postoperative AKI.

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