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Surgery Today

, Volume 41, Issue 2, pp 262–265 | Cite as

Resection of advanced stage malignant retroperitoneal neoplasms with tumor thrombus extending into the right atrium: Report of four cases

  • Yasuhiro Shudo
  • Goro Matsumiya
  • Taichi Sakaguchi
  • Tomoyuki Fujita
  • Takashi Yamauchi
  • Yoshiki Sawa
Case Report

Abstract

Surgery for retroperitoneal neoplasms with a tumor thrombus extension into the right atrium is challenging. This study reviewed four surgical cases of advanced stage malignant neoplasms with the tumor thrombus extending into the right atrium. The malignant neoplasms involved the kidney in two patients, and the liver and adrenal gland in one each. The tumor thrombus was removed through a longitudinal cavotomy and right atriotomy in all cases. The inferior vena cava reconstruction was performed by directly closing it in one patient and by pericardial patch suturing in another. Cardiopulmonary bypass was used for all procedures and a Pringle maneuver was used to reduce bleeding from the liver in three. There was no perioperative or hospital death. Two of the four with renal cell carcinoma were alive 7 and 13 months after the surgery. One with hepatocellular carcinoma died of recurrent malignancy after 4 months, while the patient with an adrenal carcinoma remained disease free after surgery. These cases indicate the safety of the present procedure. Although the long-term results are still unknown, there were favorable early results and a lack of perioperative complications. Surgical challenges in resecting an intracardiac extension of retroperitoneal malignancy require close cooperation among the attending urologist, and both gastrointestinal and cardiovascular surgeons.

Key words

Tumor thrombus Cardiopulmonary bypass Right atrium 

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References

  1. 1.
    Langenburg SE, Blackbourne LH, Sperling JW, Buchanan SA, Mauney MC, Kron IL, et al. Management of renal tumors involving the inferior vena cava. J Vasc Surg 1994;20:385–388.PubMedGoogle Scholar
  2. 2.
    Bower TC, Nagorney DM, Cherry KJ Jr, Toomey BJ, Hallett JW, Panneton JM, et al. Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg 2000;31:270–281.CrossRefPubMedGoogle Scholar
  3. 3.
    Tsuji Y, Goto A, Hara I, Ataka K, Yamashita C, Okita Y, et al. Renal cell carcinoma with extension of tumor thrombus into the vena cava: surgical strategy and prognosis. J Vasc Surg 2001;33:789–796.CrossRefPubMedGoogle Scholar
  4. 4.
    Hedican SP, Marshall FF. Adrenocortical carcinoma with intracaval extension. J Urol 1997;158:2056–2061.CrossRefPubMedGoogle Scholar
  5. 5.
    Rougier P, Milan C, Lazorthes F, Fourtanier G, Partensky C, Baumel H, et al. Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer: Fondation Francaise de Cancerologie Digestive. Br J Surg 1995;82:1397–1400.CrossRefPubMedGoogle Scholar
  6. 6.
    Berg AA. Malignant hypernephroma of the kidney, its clinical course and diagnosis, with a description of the author’s method of radical operative cure. Surg Gynecol Obstet 1913;17:463–471.Google Scholar
  7. 7.
    Nesbitt JC, Soltero ER, Dinney CP, Walsh GL, Schrump DS, Swanson DA, et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann Thorac Surg 1997;63:1592–1600.CrossRefPubMedGoogle Scholar
  8. 8.
    Hatcher PA, Anderson EE, Paulson DF, Carson CC, Robertson JE. Surgical management and prognosis of renal cell carcinoma invading the vena cava. J Urol 1991;145:20–24.PubMedGoogle Scholar
  9. 9.
    Hemming AW, Reed AI, Langham MR Jr, Fujita S, Howard RJ. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg 2004;239:712–721.CrossRefPubMedGoogle Scholar
  10. 10.
    Glazer AA, Novick AC. Long-term follow-up after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol 1996;155:448–450.CrossRefPubMedGoogle Scholar
  11. 11.
    Marshall FF, Reitz BA, Diamond DA. A new technique for the management of renal cell carcinoma involving the right atrium: hypothermia and cardiac arrest. J Urol 1984;131:103–109.PubMedGoogle Scholar
  12. 12.
    Novick AC, Kaye MC, Pontes JE, Mitchell CK, Cosgrove DM. Experience with cardiopulmonary bypass and deep hypothermic circulatory bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena caval thrombi. Ann Surg 1990;212:472–477.CrossRefPubMedGoogle Scholar
  13. 13.
    Ciancio G, Soloway MS. Renal cell carcinoma with tumor thrombus extending above diaphragma: avoiding cardiopulmonary bypass. Urology 2005;66:266–270.CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2011

Authors and Affiliations

  • Yasuhiro Shudo
    • 1
  • Goro Matsumiya
    • 1
  • Taichi Sakaguchi
    • 1
  • Tomoyuki Fujita
    • 1
  • Takashi Yamauchi
    • 1
  • Yoshiki Sawa
    • 1
  1. 1.Division of Cardiovascular Surgery, Department of SurgeryOsaka University Graduate School of MedicineOsakaJapan

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