Renal carcinoma with supradiaphragmatic tumor thrombus: avoiding sternotomy and cardiopulmonary bypass

The Annals of Thoracic Surgery
Gaetano CiancioTomas A Salerno

Abstract

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. 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. 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 recurr...Continue Reading

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Citations

Nov 5, 2011·Current Urology Reports·Javier González
Nov 9, 2010·Journal of Cardiothoracic Surgery·Haralabos ParissisVincent Young
Feb 3, 2016·The Annals of Thoracic Surgery·Mario GaudinoLeonard N Girardi
Sep 21, 2013·Journal of Cardiothoracic and Vascular Anesthesia·Kyota FukazawaGaetano Ciancio
May 28, 2013·The Annals of Thoracic Surgery·Gaetano Ciancio, Tomas A Salerno
Apr 30, 2013·The Annals of Thoracic Surgery·Jean-Noel FabianiPaul Achouh
Aug 14, 2012·Journal of Cardiothoracic and Vascular Anesthesia·Gaurav MalhotraFeroze Mahmood
May 1, 2012·The Annals of Thoracic Surgery·Jennifer L AlejoAshish S Shah
Feb 19, 2011·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·J ParraM Rouprêt
Mar 1, 2013·BJU International·Javier GonzálezGaetano Ciancio
Jan 28, 2010·The Annals of Thoracic Surgery·Alfred Culliford
Jan 25, 2011·The Annals of Thoracic Surgery·Francesco OnoratiAlessandro Mazzucco
May 9, 2015·Magnetic Resonance Imaging Clinics of North America·Gisela C MuellerPrachi P Agarwal
May 14, 2016·The Annals of Thoracic Surgery·Christopher LauLeonard N Girardi
Aug 24, 2016·The Annals of Thoracic Surgery·Tomas A Salerno, Gaetano Ciancio
Oct 9, 2015·Therapeutic Advances in Urology·Sarah P Psutka, Bradley C Leibovich
Oct 23, 2013·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Domenico CalcaterraJames A Brown
Apr 25, 2014·Innovations : Technology and Techniques in Cardiothoracic and Vascular Surgery·Dawn S HuiMark J Cunningham
Nov 19, 2013·Expert Review of Anticancer Therapy·Javier GonzálezGaetano Ciancio
Jan 1, 2012·Annals of Vascular Diseases·Kenichiro NoguchiHiroyuki Tanaka
Nov 24, 2016·Nephro-urology Monthly·Mohammad SoleimaniMohammad Reza Safarinejad
Oct 23, 2020·Current Urology Reports·Alireza Ghoreifi, Hooman Djaladat

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