title: Manual repositioning of intra-atrial kidney cancer tumor thrombus: a technique reducing the need for cardiopulmonary bypass.
abstract: OBJECTIVE
  To describe a feasible surgical technique for patients with renal cell carcinoma associated with a supradiaphragmatic tumor thrombus that avoids cardiopulmonary bypass procedure.
  
  
  METHODS
  From 2004 to 2009, 4 patients with a right kidney tumor and tumor thrombus above the diaphragm (pT3c) underwent manual repositioning of the tumor thrombus out of the right atrium into the inferior vena cava on the beating heart. These patients were aged 65.8 years and had a body mass index of 25.5 kg/m(2). Median tumor size was 10.8 cm, and 3 patients had synchronous metastasis.
  
  
  RESULTS
  Manual repositioning of the tumor thrombus was safe and feasible in all patients. Mean operating time was 561 minutes (range, 302-613 minutes), and no perioperative death occurred. Auxiliary cardiopulmonary bypass procedure was applied in 1 patient to remove a preoperatively diagnosed pulmonary embolus. Three patients subsequently underwent systemic therapy for metastatic disease. Median survival was 16 months (range, 1.7-26 months).
  
  
  CONCLUSIONS
  Manual repositioning of a vena cava tumor thrombus without cardiopulmonary bypass is a safe and feasible approach. The risk of tumor thrombembolization seems to be low, and cardiopulmonary bypass can be avoided or at least reduced to a minimum time of intervention.
authors: Department of Urology, University of Heidelberg, Heidelberg, Germany. meikeschneider@gmx.net
authors: Meike
authors: M
authors: Schneider
authors: Boris
authors: B
authors: Hadaschik
authors: Peter
authors: P
authors: Hallscheidt
authors: Hildegard
authors: H
authors: Jakobi
authors: Markus
authors: M
authors: Fritz
authors: Johann
authors: J
authors: Motsch
authors: Sascha
authors: S
authors: Pahernik
authors: Markus
authors: M
authors: Hohenfellner
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006325:Heart Atria; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D014682:Vena Cava, Inferior