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

• Published in: International urology and nephrology Vol. 43; no. 4; pp. 1033 - 1038
• Main Authors: Radak, Djordje, Milojevic, Predrag, Babic, Srdjan, Matic, Predrag, Tanaskovic, Slobodan, Vukotic, Vinka, Pejcic, Tomislav, Hadzi-Djokic, Jovan
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2011; Springer Nature B.V
• Subjects: Adult; Aged; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Female; Follow-Up Studies; Heart Atria - pathology; Heart Atria - surgery; Heart Neoplasms - secondary; Heart Neoplasms - surgery; Humans; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplastic Cells, Circulating - pathology; Nephrectomy - methods; Nephrology; Thrombectomy - methods; Time Factors; Urology; Urology – Original Paper; Vascular Neoplasms - secondary; Vascular Neoplasms - surgery; Vena Cava, Inferior - pathology; Vena Cava, Inferior - surgery; Venous Thrombosis - pathology; Venous Thrombosis - surgery; Young Adult; Renal cell cancer; Tumor thrombus; Atrial thrombus; Tumor thrombectomy; Inferior vena cava
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-011-9937-6

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.