Surgery for adrenal tumours with thrombus in the supra-diaphragmatic infra-atrial inferior vena cava, with no cardiopulmonary bypass.
OBJECTIVE
To assess the result of surgery for adrenal neoplasia with thrombus in the supra-diaphragmatic infra-atrial inferior vena cava.


METHODS
Five patients with adrenal cortex carcinoma and three with phaeochromocytoma were reviewed. All the thrombi were removed through a right thoracophrenolaparotomy in the fifth intercostal space, with clamping of the intrathoracic portion of the inferior vena cava, with no cardiopulmonary bypass. In the first two cases the thrombi were removed in a second surgical procedure after resecting the tumours. In the other six the complete procedure was done in one surgical stage.


RESULTS
There were no surgery-related deaths. The major complications after surgery were pulmonary atelectasis, acute renal failure, a large retroperitoneal collection, deep vein thrombosis and pulmonary embolism, each in one patient. Of the five patients with adrenal cortex carcinoma one is still alive after 15 years with no evidence of disease, one is alive with pulmonary metastases 15 months after surgery and the other three died from widespread disease after 5, 12 and 15 months. Of the three patients with phaeochromocytoma, two show no evidence of the disease 2.5 and 11 years later and one died from myocardial infarction, with no evidence of the disease, 9 years later.


CONCLUSIONS
Thrombi from adrenal neoplasia in the supra-diaphragmatic infra-atrial inferior vena cava may be removed with no need for cardiopulmonary bypass and cardiac arrest, thus avoiding the associated morbidity and high cost.
Lucon
Antonio M
AM
Division of Urology and Endocrinology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo/SP, Brazil. mlucon@uol.com.br
Machado
Marcel C C
MC
Pereira
Maria A A
MA
Mendonça
Berenice B
BB
Praxedes
Jose N
JN
Arap
Sami
S
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary; D008175:Lung Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010673:Pheochromocytoma / Q000150:complications / Q000601:surgery*; D017131:Thrombectomy / Q000379:methods*; D014682:Vena Cava, Inferior / Q000601:surgery*; D020246:Venous Thrombosis / Q000150:complications / Q000601:surgery*