Resection of cavoatrial renal cell carcinoma employing total circulatory arrest
D. M. Shahian, J. A. Libertino, L. N. Zinman, H. K. Leonardi and R. C. Eyre
Department of Thoracic and Cardiovascular Surgery, Lahey Clinic Medical Center, Burlington, Mass. 01805.
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.
