title: Concomitant surgery for renal neoplasm with pulmonary tumor embolism.
abstract: OBJECTIVE
  Gross tumor pulmonary embolism from renal carcinoma is rarely diagnosed preoperatively. Individual cases of intraoperative embolization of tumor during radical resection of the kidney have been reported. We report on 9 patients who underwent pulmonary arterial tumor removal concomitant with nephrectomy.
  
  
  METHODS
  Between 2000 and 2008, 9 patients underwent simultaneous nephrectomy and removal of gross embolic tumor from the pulmonary arteries. In 7 of these patients the diagnosis was made preoperatively by either computed tomography or magnetic resonance imaging. Cardiopulmonary bypass was used in all cases. Bilateral removal of pulmonary artery tumor was required in 7 patients and unilateral in 2.
  
  
  RESULTS
  All patients survived to hospital discharge after a median stay of 8.8 days (mean, 6-17 days). Two patients are currently alive 4 and 56 months after the operation. Six patients died of distant metastasis or local recurrence of disease after 6, 9, 12, 17, 25, and 29 months. Actuarial survival at 6 months, 1, 2, and 3 years was 100%, 75%, 50%, and 25%, respectively.
  
  
  CONCLUSIONS
  Pulmonary artery embolic tumor removal concomitant with nephrectomy for renal carcinoma can be performed safely. Survival of patients with combined surgery is comparable with that of patients with the same stage of renal neoplasm without pulmonary tumor embolism. The pulmonary tumor embolism in patients with renal carcinoma should be considered as extension of vena caval tumor but not as a distant metastasis. Pulmonary tumor removal provides symptomatic relief and may provide a survival benefit in these patients.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
authors: Nihan
authors: N
authors: Kayalar
authors: Bradley C
authors: BC
authors: Leibovich
authors: Thomas A
authors: TA
authors: Orszulak
authors: Hartzell V
authors: HV
authors: Schaff
authors: Thoralf M
authors: TM
authors: Sundt
authors: Richard C
authors: RC
authors: Daly
authors: Christopher G A
authors: CG
authors: McGregor
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D019043:Vascular Neoplasms / Q000473:pathology*; D014682:Vena Cava, Inferior / Q000473:pathology*