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David M. Shahian, MD; John A. Libertino, MD; Leonard N. Zinman, MD; Howard K. Leonardi, MD; Robert C. Eyre, MD

Arch Surg. 1990;125(6):727-732.

Abstract
• Intracaval extension of renal cell carcinoma to the right atrium is a life-threatening presentation that may result in fatal tricuspid valve obstruction or pulmonary embolization. From 1981 to 1989 we treated 10 patients with such extension of tumor, the last 7 of whom underwent resection in which hypothermic circulatory arrest was used. No postoperative deaths, myocardial infarctions, or strokes occurred. Four patients were alive with no evidence of disease at 4,10,16, and 39 months after resection, and 1 patient was alive with pulmonary and spine metastases at 34 months after resection. Two patients died of metastatic disease at 7 and 12 months. In the absence of diffuse metastatic disease, lymph-node involvement, or invasion of contiguous organs, radical resection of cavoatrial hypernephroma may result in excellent palliation and possibly a cure.

(Arch Surg. 1990;125:727-732)

Author Affiliations
From the Departments of Thoracic and Cardiovascular Surgery (Dr Shahian) and Urology (Drs Libertino and Zinman), Lahey Clinic Medical Center, Burlington, Mass, and the Divisions of Thoracic and Cardiovascular Surgery (Drs Shahian and Leonardi) and Urology (Dr Eyre), New England Deaconess Hospital, Boston, Mass.

Footnotes
Accepted for publication January 30, 1990.

Presented before the 70th Annual Meeting of the New England Surgical Society, Bretton Woods, NH, September 23, 1989.

Reprint requests to the Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, 41 Mall Rd, Burlington, MA 01805 (Dr Shahian).

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