Renal Carcinoma With Supradiaphragmatic Tumor Thrombus

Avoiding Sternotomy and Cardiopulmonary Bypass

Gaetano Ciancio, Samir P. Shirodkar, Mark S. Soloway, Alan Livingstone, Michael Barron, Tomas Salerno

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Renal cell carcinoma with tumor thrombus extension into the inferior vena cava (IVC) is rare. Surgical resection provides the only reasonable chance for cure, but the approach poses a challenge to the surgical team. We describe our technique to safely resect these tumors through a transabdominal incision that exposes the intrapericardial IVC and right atrium (RA) transdiaphragmatically, without the use of sternotomy, cardiopulmonary bypass (CBP), or deep hypothermic circulatory arrest (DHCA). Clinical outcomes of these patients and techniques are reported. Methods: Between May 1997 and January 2009, 102 patients (mean age, 63 years) underwent resection of renal tumor extending into the IVC by techniques developed to avoid sternotomy and CBP. The tumor thrombus in 12 patients (13%) extended into the supradiaphragmatic IVC and RA. Results: Complete resection was successful through the transabdominal approach without CBP in all patients. Mean operative time was 8 hours 15 minutes. Estimated blood loss was 2960 mL, and a mean of 9 U of blood was transfused. Two patients died postoperatively, 1 on day 4 of arrhythmia and 1 on day 22 of multisystem organ failure. All discharged patients were alive at the last follow-up. Three patients had tumor recurrence and have been referred for adjuvant therapy. Conclusions: In select cases, renal cell carcinoma extending into the IVC to the intrapericardial level and RA can be resected without sternotomy, CBP, or DHCA.

Original languageEnglish
Pages (from-to)505-510
Number of pages6
JournalAnnals of Thoracic Surgery
Volume89
Issue number2
DOIs
StatePublished - Feb 1 2010

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Sternotomy
Cardiopulmonary Bypass
Inferior Vena Cava
Thrombosis
Carcinoma
Kidney
Heart Atria
Deep Hypothermia Induced Circulatory Arrest
Neoplasms
Renal Cell Carcinoma
Operative Time
Cardiac Arrhythmias
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Renal Carcinoma With Supradiaphragmatic Tumor Thrombus : Avoiding Sternotomy and Cardiopulmonary Bypass. / Ciancio, Gaetano; Shirodkar, Samir P.; Soloway, Mark S.; Livingstone, Alan; Barron, Michael; Salerno, Tomas.

In: Annals of Thoracic Surgery, Vol. 89, No. 2, 01.02.2010, p. 505-510.

Research output: Contribution to journalArticle

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