Concomitant surgery for renal neoplasm with pulmonary tumor embolism.
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.
Kayalar
Nihan
N
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn 55905, USA.
Leibovich
Bradley C
BC
Orszulak
Thomas A
TA
Schaff
Hartzell V
HV
Sundt
Thoralf M
TM
Daly
Richard C
RC
McGregor
Christopher G A
CG
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*