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  • Title: Renal cell carcinoma with tumor thrombus extending above diaphragm: avoiding cardiopulmonary bypass.
    Author: Ciancio G, Soloway MS.
    Journal: Urology; 2005 Aug; 66(2):266-70. PubMed ID: 16098354.
    Abstract:
    OBJECTIVES: Renal cell carcinoma with a tumor thrombus extending into the supradiaphragmatic inferior vena cava (IVC) and right atrium represents a challenge to the surgical team. We describe a technique that can be used to resect these tumors safely through a transabdominal approach without recourse to cardiopulmonary bypass (CPB) or entry into the thoracic cavity. METHODS: Between May 1997 and August 2004, 59 patients (mean age 61 years) underwent surgical resection of a renal tumor extending into the IVC by techniques developed with the intention to avoid sternotomy and CPB. In 7 patients (12%), the tumor thrombus extended into the supradiaphragmatic IVC and right atrium. Complete surgical resection was successful through a transabdominal approach without CPB in all 7 of these patients. RESULTS: In the 7 patients who underwent the described technique, the median age was 71 years (range 51 to 80). The mean operative time was 7 hours, 47 minutes. The mean estimated blood loss was 2514 mL (range 500 to 6000). The mean number of blood units transfused was 4.7 (range 0 to 11). One patient died in the immediate postoperative period of cardiac arrhythmia. The median follow-up was 11.1 months, and 5 patients were disease free. CONCLUSIONS: In select cases, renal cell carcinoma extending into the supradiaphragmatic IVC and right atrium can be resected without the use of CPB. We describe our technique.
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