Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

J Cardiothorac Surg. 2010 Nov 5;5:103. doi: 10.1186/1749-8090-5-103.

Abstract

Background: The techniques for the resection of renal tumors with IVC extension are based on the experience of individual units. We attempt to provide a logical approach of the surgical strategies in a stepwise fashion.

Methods: Over 6-years 9 patients with renal cell carcinoma invading the IVC, underwent surgery. There were 6 males. The extension was at level IV in 4 and III in 5 cases. CPB used in 8 and hypothermia and circulatory arrest in all patients with level IV disease. The results and an algorithm of the plan of action, as per level of extension are presented.

Results: Plan of action: For level I-II disease: No Cardiothoracic involvement, For level III: Cardiopulmonary Bypass (CPB) & control of the cavo-atrial junction. For level IV: use of brief periods of Circulatory Arrest & repair of the Cavotomy with a pericardial patch. Postoperative morbidity: prolonged ICU stay, 3 patients (33.3%); tracheostomy, 1 (11.1%); Sepsis, 2 (22.2%); CVA 1, (11.1%). Mortality: 2 patients (22.2%)

Conclusions: Total clearance of the IVC from an adherent tumor is important, therefore extensive level IV disease presents a surgical challenge.We recommend CPB for level III and brief periods of Total Circulatory Arrest (TCA) for level IV disease.

MeSH terms

  • Carcinoma, Renal Cell / pathology
  • Carcinoma, Renal Cell / surgery*
  • Female
  • Humans
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / surgery*
  • Male
  • Neoplasm Invasiveness
  • Neoplastic Cells, Circulating / pathology
  • Vena Cava, Inferior / pathology
  • Vena Cava, Inferior / surgery*