Deep hypothermia and circulatory arrest in the surgical management of renal tumors with cavoatrial extension.
BACKGROUND
The inferior vena cava (IVC) is involved in almost 5% to 10% of renal tumors. Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus.


METHODS
From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case.


METHODS
Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease.


RESULTS
There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence.


CONCLUSIONS
The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation.
Dedeilias
Panagiotis
P
1st Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.
Koletsis
Efstratios
E
Rousakis
Antonios G
AG
Kouerinis
Ilias
I
Zaragkas
Stylianos
S
Grigorakis
Alkis
A
Leivaditis
Vassilios
V
Malovrouvas
Dimitrios
D
Apostolakis
Efstratios
E
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000473:pathology*