[Spinal cord infarction following radical nephrectomy using extracorporeal circulation for renal cell carcinoma with tumor thrombus in the inferior vena cava and right atrium: a case report].
A 51 year-old man admitted to our hospital for macroscopic hematuria and right abdominal mass. CT demonstrated a large hypervascular mass and tumor thrombus in the inferior vena cava and right atrium. We diagnosed right renal cancer (stage III), and he underwent radical nephrectomy and resection of tumor thrombus with extracorporeal circulation. Operative time was 9 hours. Time for extracorporeal circulation was 119 minutes, and it took 60 minutes for intraoperative balloon occlusion of descending aorta in order to arrest hemorrhage. Pathological diagnosis was clear cell carcinoma of the kidney (pT3c, N0, M0). Four days after surgery, paraplegia was evident, and a diagnosis of spinal cord infarction was made based on neurologic examination and MRI findings. In cases with such a surgery requiring extracorporeal circulation, preoperative meeting with cardiologists and anesthetists is indispensable in order to fully understand the possible complications. Especially, to keep a careful watch and prepare for spinal cord ischemia is mandatory.
Sumino
Yasuhiro
Y
Department of Urology, Oita University Faculty of Medicine, Oita, Japan.
Sato
Fuminori
F
Mimata
Hiromitsu
H
D019917:Blood Vessel Prosthesis Implantation; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002404:Catheterization / Q000009:adverse effects; D005112:Extracorporeal Circulation; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy; D010264:Paraplegia / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology*; D013116:Spinal Cord / Q000098:blood supply*; D014682:Vena Cava, Inferior / Q000601:surgery*