Surgical management of renal carcinoma with extensive involvement of the vena cava and right atrium.
Between 1988 and 1990, 8 patients with a renal tumour extending into the vena cava and with supradiaphragmatic extension were treated by an operative technique involving extracorporeal circulation and deep hypothermic circulatory arrest. In 4 patients the thrombus extended into the right atrium. Six patients appeared to have a renal carcinoma. Intra-operatively one patient's tumour proved to be a metastasis of a squamous cell carcinoma of the lung and another patient was found post-operatively to have a leiomyosarcoma of the vena cava. Two of these 6 patients died from metastases 6 weeks and 8 months post-operatively. Four patients are symptom-free, although 3 of them have liver or lung metastases 10, 20 and 37 months post-operatively. One has no evidence of disease 18 months post-operatively. The use of extracorporeal circulation and deep hypothermic circulatory arrest provides optimal surgical exposure and gives the patients a considerable complaint-free interval post-operatively. How often cure is also achieved is as yet unclear.
Davits
R J
RJ
Department of Urology, Erasmus University and Academic Hospital Dijkzigt, Rotterdam, The Netherlands.
Blom
J H
JH
Schröder
F H
FH
D000368:Aged; D005112:Extracorporeal Circulation; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000601:surgery; D006338:Heart Neoplasms / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D007890:Leiomyosarcoma / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D014684:Venae Cavae / Q000601:surgery*