Usefulness of cardiopulmonary bypass in reconstruction of inferior vena cava occupied by renal cell carcinoma tumor thrombus

Aggressive surgical treatment in renal cell carcinoma is still controversia l. The aim of this paper is to assess inferior vena caval (IVC) reconstruct ion for suprahepatic vena caval renal cell carcinoma (RCC) tumor thrombus. Twelve patients with suprahepatic vena caval thrombus from renal cell carci noma who underwent surgical repair with cardiopulmonary bypass were evaluat ed. The vena caval defect was reconstructed by direct suture, patch repair, or graft replacement. Of 12 patients undergoing partial cardiopulmonary bypass, tumor thrombus ex tended to the junction of the hepatic vein in three patients and to the rig ht atrium in one. Tumor thrombus was removed manually or with balloon cathe ter. Tumor thrombus in the right atrium was removed during electrical ventr icular fibrillation. Repair of the IVC was performed by direct suture of th e IVC wall in two patients, patch repair with expanded polytetrafluoroethyl ene (EPTFE) graft in seven, and graft replacement with an EPTFE graft in th ree. There were no operative deaths and the only postoperative complication was one patient death from pulmonary emboli. The four patients with nonloc alized disease died within 2 years, but four patients lived for more than 3 years postoperatively. Survival was 37.5% at 3 years and 18.8% at 5 years by the Kaplan-Meier's method. Conclusions: (1) Partial cardiopulmonary bypass is useful for the control o f bleeding when tumor thrombus in the IVC extends to the junction of the he patic vein. (2) Nephrectomy with tumor thrombectomy of the IVC is valuable, and long-term survival is possible in patients without distant metastases or regional lymph node metastases.