title: [Perioperative management of two patients with renal malignant tumor involving the vena cava].
abstract: Two patients underwent resection of renal malignant tumors involving vena cava. Such tumors occasionally extend to the inferior vena cava with tumor thrombus and invasion to the lymph nodes and adjacent organs. Perioperative management of patients with these tumors is difficult because of the risk of pulmonary embolism and massive bleeding, and requires appropriate cooperation among the surgical team. In case 1, a 56-year-old man, renal cell carcinoma with tumor thrombus had extended into the intrahepatic vena cava. It was resected after isolating the liver from vena cava and incising the cross-clamped inferior vena cava without extracorporeal circulation or blood transfusion. A prosthetic graft replaced the inferior vena cava. In case 2, a 64-year-old woman, renal pelvis cancer adhered to the inferior vena cava and the mesentery with enlarged lymph nodes. It was separated from the inferior vena cava and removed with the ascending colon. The patient received a blood transfusion of approximately 2,000ml. Cardiomyopathy associated with a left ventricular outflow tract pressure gradient of 100mmHg required perioperative management. After surgery, both patients underwent controlled ventilation in the intensive care unit. After recovery, they were discharged without complications. We discuss perioperative management, with regard to the level of the tumor extension and perioperative complications.
authors.affiliation: Division of Anesthesiology, Hamamatsu Rosai Hospital, Hamamatsu 430-8525.
authors.forename: Tsunehisa
authors.initials: T
authors.lastname: Sato
authors.forename: Mutsuhito
authors.initials: M
authors.lastname: Kikura
authors.forename: Go
authors.initials: G
authors.lastname: Kobori
authors.forename: Shuhei
authors.initials: S
authors.lastname: Goto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Seiji
authors.initials: S
authors.lastname: Moroi
authors.forename: Shiro
authors.initials: S
authors.lastname: Koi
authors.forename: Akira
authors.initials: A
authors.lastname: Iwai
authors.forename: Harutaka
authors.initials: H
authors.lastname: Inoue
authors.forename: Naoki
authors.initials: N
authors.lastname: Teratani
authors.forename: Junichi
authors.initials: J
authors.lastname: Kaganoi
authors.forename: Noboru
authors.initials: N
authors.lastname: Nakayama
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Takatoku
authors.forename: Hiroomi
authors.initials: H
authors.lastname: Nishio
authors.forename: Takayuki
authors.initials: T
authors.lastname: Aoki
authors.forename: Junichiro
authors.initials: J
authors.lastname: Nishizawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kanda
authors.forename: Eiji
authors.initials: E
authors.lastname: Shinoda
mesh_terms: D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D019990:Perioperative Care / Q000379:methods*; D014682:Vena Cava, Inferior / Q000473:pathology*