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 improves the survival of patients with transvenous intracardiac tumor extension of renal cell carcinomas. A less invasive surgical approach avoiding deep hypothermia, circulatory arrest, and cross-clamping of the aorta is presented. Methods: Between 1987 and 1999, 12 patients (mean age 57 +/- 8 years) underwent resection of a renal cell carcinoma extending into the right atrium, right ventricle, or pulmonary arteries. After median sterno-laparotomy, normothermic cardiopulmonary bypass is used cannulating the ascending aorta, superior caval vein, and inferior caval vein below the renal veins. The tumor and the corresponding kidney are radically excised, including the renal 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 patient was 1200 mt. Mean duration of postoperative mechanical ventilation was 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 hospitalization 22 +/- 12 days (median 21; range 10-58 days). All patients were discharged home. Patients with multiple tumor manifestations outside the cardiovascular systems died within 9 months after the operation. Conclusions: The use of normothermic cardiopulmonary bypass is a less invasive method for radical resection of renal cell carcinoma with intracardiac tumor extension. Radical resection does not improve survival in patients with multiple distant metastases.