Less invasive surgical treatment of renal cell carcinomas extending into the right heart and pulmonary arteries: Surgery for renal cell carcinoma

Background: Radical resection using deep hypothermic circulatory arrest imp roves the survival of patients with transvenous intracardiac tumor extensio n of renal cell carcinomas. A less invasive surgical approach avoiding deep hypothermia, circulatory arrest, and cross-clamping of the aorta is presen ted. Methods: Between 1987 and 1999, 12 patients (mean age 57 +/- 8 years) underwent resection of a renal cell carcinoma extending into the right atri um, right ventricle, or pulmonary arteries. After median sterno-laparotomy, normothermic cardiopulmonary bypass is used cannulating the ascending aort a, superior caval vein, and inferior caval vein below the renal veins. The tumor and the corresponding kidney are radically excised, including the ren al vein. Tumor fragments from the inferior caval vein, the right heart, and pulmonary arteries are removed either on the fibrillating or beating heart . Results: Operative mortality was 0%. Mean cardiopulmonary bypass time was 53 +/- 27 minutes (median 36; range 32-110 minutes). Mean blood loss per p atient was 1200 mt. Mean duration of postoperative mechanical ventilation w as 36 +/- 12 hours (median 36; range 30-77 hours), mean intensive care stay 5.5 +/- 5 days (median 3; range 1-48 days), and mean duration of hospitali zation 22 +/- 12 days (median 21; range 10-58 days). All patients were disc harged home. Patients with multiple tumor manifestations outside the cardio vascular systems died within 9 months after the operation. Conclusions: The use of normothermic cardiopulmonary bypass is a less invasive method for r adical resection of renal cell carcinoma with intracardiac tumor extension. Radical resection does not improve survival in patients with multiple dist ant metastases.