A CASE REPORT OF RENAL CELL CARCINOMA WITH TUMOR THROMBUS EXTENDING INTO SUPRAHEPATIC VENA CAVA INFERIOR OPERATED USING CARDIOPULMONARY BYPASS

Objective: Renal cell carcinoma (RCC) with tumor thrombus in the inferior vena cava (IVC) presents surgeons with a technical intraoperative challenge because of the need for aggressive surgical management. In this study, we describe our method for surgical management with cardiopulmonary bypass (CPB) and investigate the long-term outcomes of RCC patients with and without CPB. Methods: Fifteen patients with RCC underwent nephrectomy and IVC thrombectomy from May 2011 to December 2017. We retrospectively reviewed and analyzed the clinical course of all patients. Novick classification was used to assess the level of tumor thrombus extension into the IVC. Patient characteristics, surgical procedures, and postoperative outcome data in both groups were collected. Results: Twelve patients were male and 3 were female, with an average age of 62.9 ± 10.9 years (range 46 to 82). The average operative times were 824 ± 335 minutes in the patients with CPB and 646 ± 162 minutes in those without CPB (P = .17). The average amount of intraoperative bleeding was 2125 ± 1315 ml in the patients with CPB and 3333 ± 1431 ml in those without CPB (P = .14). The same tendency was observed in patients of Novick levels 3 and 4. The mean observation period was 1061.4 days. No 30-day mortality was noted. There was no significant difference in all-cause survival between the patients with CPB and those without. Conclusions: We conclude that surgical management with CPB and circulatory arrest may be a viable and safe method of treatment for RCC patients.

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Normothermic Cardiopulmonary Bypass with Beating Heart for Management of Renal Cell Carcinoma with Atrial Tumor Thrombus

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000008 ◽

2013 ◽

Vol 8 (4) ◽

pp. 316-319 ◽

Cited By ~ 5

Author(s):

Domenico Calcaterra ◽

Thomas E. Collins ◽

Joseph W. Turek ◽

Kalpaj R. Parekh ◽

Mohammad Bashir ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cardiopulmonary Bypass ◽

Cell Carcinoma ◽

Right Atrium ◽

Renal Cell ◽

Tumor Thrombus ◽

Vena Cava ◽

Hospital Length Of Stay ◽

Advanced Tumor Stage ◽

The Right

Renal cell carcinoma is occasionally complicated by the formation of a neoplastic thrombus invading the inferior vena cava. Rarely, the thrombus extends into the vena cava, reaching the right atrium. In these situations, despite the advanced tumor stage, surgical resection continues to offer the best chance for effective treatment. The operation requires a complex surgical approach with mobilization of the liver and use, in most cases, of extracorporeal circulation, which allows removal of the tumor thrombus from the right atrium. Traditionally, the intervention is performed using deep hypo-thermic circulatory arrest or, less frequently, using moderate hypothermia, aortic cross clamping, and cardioplegic cardiac arrest. These strategies have the downside of causing increased blood loss, coagulopathy, and long operative time and can potentially have a negative impact on survival. We report a different operative approach using normothermic cardiopulmonary bypass, with the expectation of lowering the rate of blood product transfusions, hospital length of stay, and overall incidence of complications.

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