Renal tumor with tumor thrombus in inferior vena cava and right atrium: the report of five cases with long-term follow-up

Djordje Radak, Predrag Milojevic, Srdjan Babic, Predrag Matic, Slobodan Tanaskovic, Vinka Vukotic, Tomislav Pejcic, Jovan Hadzi-Djokic
International Urology and Nephrology 2011, 43 (4): 1033-8

OBJECTIVE: To evaluate early and long-term results of radical surgical removal of renal cell cancer (RCC) with tumor thrombus (TT) in the inferior vena cava (IVC) and right atrium (RA).

METHODS: The study included five patients with RCC with TT in IVC and right atrium, operated from January 2004 to September 2009 in the Institute for Cardiovascular disease "Dedinje", Belgrade, Serbia. All patients underwent atrial and caval thrombectomy with the use of normothermic cardiopulmonary bypass (CPB) and the radical nephrectomy, by a joint cardiovascular and urological team. After the surgery, patients were evaluated every 3 months for the first year, every 6 months for the next 2 years, and yearly thereafter. The mean follow-up was 32.6 months (range: 7-67 months).

RESULTS: There were no per-operative embolism and no in-hospital deaths. Two patients developed tumor recurrence during a mean time of 5 months and died within 1 year after the surgery. The three remaining patients are alive (mean follow-up: 48 months) and without the evidence of tumor recurrence or metastases. No patients received adjuvant therapy.

CONCLUSIONS: Patients with RCC and the extension of TT in IVC and right atrium need a multidisciplinary surgical strategy. Atrial and caval tumor thrombectomy can be performed safely and effectively, with a low complication rate, using normothermic CPB. Long-term results are promising; however, larger prospective multicentre studies are necessary.

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