title: Surgical treatment of renal carcinoma with atrial tumor thrombus avoiding cardiopulmonary bypass: step-by-step description.
abstract: Tumor thrombus in the inferior vena cava (IVC) occurs in 4-10% of patients with renal cell carcinoma (RCC) and poses a challenge for the surgical team. Because there is no systemic therapy available to significantly reduce tumor burden, surgical intervention is the only treatment. However, the surgical approach is associated with significant morbidity and mortality. When the thrombus extends above the diaphragm, the use of cardiopulmonary bypass (CPB) and accompanying deep hypothermic circulatory arrest (DHCA) has usually been advocated. However, complications inherent to CPB and DHCA, such as coagulopathy and central nervous system complications, have led us to search for an alternative surgical approach to these tumors. The purpose of this study is to describe the surgical technique used in five patients with large RCC with tumor thrombus extending into the supradiaphragmatic IVC and Right atrium (RA), Right atrium, who underwent extensive resection without CPB and DHCA.
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Guglielmo
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Melandro
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Montalto
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Poli
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Fatima
authors.initials: F
authors.lastname: Della Pietra
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mazzesi
authors.affiliation: Department of General Surgery and Human Organs Transplant. "Sapienza" University of Rome - Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Berloco
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006325:Heart Atria; D006338:Heart Neoplasms / Q000556:secondary* / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D014682:Vena Cava, Inferior