Resection of renal cell carcinomas with inferior vena caval extension using deep hypothermic circulatory arrest

Renal cell carcinoma with turnout thrombus extension into the inferior vena cava presents a difficult surgical challenge. The conventional surgical ap proach, which involves isolating the inferior vena cava, incising its wall and removing the thrombus, can have high incidences of perioperative mortal ity and embolization of the turnout thrombus compounded by severe hemorrhag e. Four patients with renal cell carcinomas extending into the inferior ven a cava were supported with cardiopulmonary bypass and deep hypothermic circ ulatory arrest during turnout excision. All of the operations were successf ully performed with no mortality and minimal morbidity. The technique allow ed the surgeon to operate in a bloodless field, thereby improving visibilit y and allowing complete tumour excision without significantly prolonging op erative time. It is believed that this technique has improved the safety an d technical feasibility of what had previously been a complicated and risky surgical procedure.