title: Renal and adrenal tumors with cardiac invasion: immediate surgical results in 14 patients.
abstract: BACKGROUND
  The resection of tumor thrombus of the inferior vena cava (IVC) and right atrium (RA) increases the survival rate of patients with renal/adrenal cancer.
  
  
  OBJECTIVE
  To evaluate the surgical procedure in cases of IVC and RA in the treatment of renal and adrenal tumors.
  
  
  METHODS
  Fourteen patients undergoing surgical intervention (during the period) between January 1997 and June 2007, for resection of IVC and/or RA thrombus due to renal or adrenal tumors, were retrospectively evaluated. The patients (64.2% male) presented with Wilms' tumor, clear cell carcinoma and adrenal adenocarcinoma, and had mean age of 4.5, 60.5 and 2.5 years, respectively. Epidemiological characteristics and intra- and postoperative parameters were evaluated.
  
  
  RESULTS
  Suprahepatic IVC tumor thrombus were observed in all the patients, and in 62.4% of them the thrombus invaded the RA. Thrombectomy was performed with extracorporeal circulation with deep hypothermia and total circulatory arrest in 85.7%, with mild hypothermia in the remaining cases. The inferior vena cava was ligated in 7.1% of the cases, and reconstruction with suture was performed in 92.9% of the patients. The duration of orotracheal intubation and length of hospital stay were different, according to the tumor type. Two deaths, due to intraoperative cardiorespiratory arrest, were seen among patients with adrenal adenocarcinoma.
  
  
  CONCLUSIONS
  IVC and RA tumor thrombi are more frequent in patients with Wilms' tumor. More postoperative complications are seen in patients with adrenal adenocarcinoma, and the postoperative prognosis is better for patients with Wilms' tumor.
authors.affiliation: Disciplina de Cirurgia Cardiovascular, Departamento de Cirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brasil. rafael.locali@hotmail.com
authors.forename: Rafael Fagionato
authors.initials: RF
authors.lastname: Locali
authors.forename: Priscila Katsumi
authors.initials: PK
authors.lastname: Matsuoka
authors.forename: Tiago
authors.initials: T
authors.lastname: Cherbo
authors.forename: Edmo Atique
authors.initials: EA
authors.lastname: Gabriel
authors.forename: Enio
authors.initials: E
authors.lastname: Buffolo
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery; D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000473:pathology*; D000328:Adult; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods; D005112:Extracorporeal Circulation / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006338:Heart Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D017131:Thrombectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000601:surgery*; D009396:Wilms Tumor / Q000473:pathology / Q000601:surgery; D055815:Young Adult