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Original Articles: Adult Cardiac

Renal Carcinoma With Supradiaphragmatic Tumor Thrombus: Avoiding Sternotomy and Cardiopulmonary Bypass

^a Department of Surgery, Division of Transplantation, University of Miami Miller School of Medicine, Miami, Florida
^b Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
^c Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida
^d Department of Anesthesia, University of Miami Miller School of Medicine, Miami, Florida
^e Department of Surgery, Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine, Miami, Florida

Accepted for publication November 9, 2009.

^_* Address correspondence to Dr Ciancio, University of Miami Miller School of Medicine, Department of Surgery, Division of Transplantation, PO Box 012440, Miami, FL 33101 (Email: gciancio{at}miami.edu).

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.

Related Article

Invited Commentary

Alfred Culliford
Ann. Thorac. Surg. 2010 89: 511. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				S. P. Shirodkar, T. A. Salerno, and G. Ciancio Reply Ann. Thorac. Surg., February 1, 2011; 91(2): 641 - 642. [Full Text] [PDF]

				F. Onorati, F. Santini, M. Telesca, G. F. Veraldi, G. Faggian, and A. Mazzucco Avoiding Sternotomy and Cardiopulmonary Bypass in Type IV Renal Carcinoma: Is It Really Worth It? Ann. Thorac. Surg., February 1, 2011; 91(2): 640 - 641. [Full Text] [PDF]

				A. Culliford Invited Commentary Ann. Thorac. Surg., February 1, 2010; 89(2): 511 - 511. [Full Text] [PDF]