INTERDISCIPLINARY OPERATIVE THERAPY FOR R ENAL TUMORS WITH INTRACARDIAC TUMOR THROMBOSIS

A combination of increased perioperative morbidity, together with the technical difficulty of an R 0 (curative) resection, is responsible fo r the poor prognostic factors of supradiaphragmatically extending rena l tumors. Six patients aged 53-70 years with vena cava thrombosis exte nding into the right atrium or ventricle underwent en bloc resection o f the primary tumor and tumor thrombus removal. If the atrial tumor ma ss was large or extended into the ventricle, resection was performed d uring cardiopulmonary arrest using a cardiopulmonary bypass method wit h the patient in deep hypothermia (< 18 degrees C). Alternatively, if the cardiac tumor infiltration was minimal, resection was performed du ring an optionally short cardiopulmonary arrest period using a cardiop ulmonary bypass method with the patient in hypothermia (23 degrees C). The operative procedure was determined by intracardiac tumor extensio n, tumor wall adhesions and tumor wall infiltrations, all of which wer e assessed intraoperatively by vena cava sonography. Six patients were strongly symptomatic preoperatively. Three developed sudden life-thre atening cardiopulmonary insufficiency, possibly due to longer-lasting tricuspital valve prolapse with a consecutive right-to-left shunt thro ugh a newly reopened foramen ovale. One patient died 14 months postope ratively because of multiple metastases (hepatic, pulmonary and bone). One patient is still alive and has had a local recurrence for 2 month s, which was diagnosed 65 months postoperatively. The remaining four p atients are alive and well. They have been tumor-free for extended per iods of time (29, 34, 62 and 84 months, respectively).