Vascular control for resection of suprahepatic intracaval Wilms' tumor: Technical considerations

The surgical resection of Wilms' tumor can be complicated by tumor thrombus extension into the inferior vena cava. In cases of suprahepatic Wilms' tum or thrombus that may extend into the right atrium, a median sternotomy and cardiopulmonary bypass (CPB) are used to facilitate tumor resection. Howeve r, if the tumor can be localized and controlled below the atrium, resection without the use of cardiopulmonary bypass may limit morbidity. The authors describe a novel approach to tumor thrombectomy for a Wilms' tumor extendi ng to the suprahepatic vena cava without the use of CPB. The authors used t ransesophageal echo-cardiography to localize the tumor thrombus and detect any tumor or air embolization and a minimal lower sternotomy to obtain intr apericardial control of the inferior vena cava. This technique may be usefu l in selected cases of Wilms' tumor as an alternative to median sternotomy and use of cardiopulmonary bypass. J Pediatr Surg 35:1836-1837. Copyright ( C) 2000 by W.B. Saunders Company.