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Renal tumours with cavo-atrial extension: surgical management and outcome

^a Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
^b Department of Urology, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK
^c Department of Anaesthesia, University Hospital Birmingham NHS Trust, Queen Elizabeth Hospital, Birmingham, UK

Corresponding author. 36 Norman Road, Walsall, Brookehouse, Walsall WS5 3QL, UK. Tel.: +44 121 6272541; fax: +44 121 6275736.

E-mail address: mankalkat{at}hotmail.com (M.S. Kalkat).

Surgery is the most effective treatment for the management of patients with renal cell carcinoma (RCC) and involvement of inferior vena cava (IVC). Data were accrued for 68 consecutive patients, who underwent surgical resection for RCC with IVC extension and required cardiothoracic surgical input from May 1993 to May 2005. The mean age of patients was 60.7 years (range 25–84, S.D. 11.6 years), 49 of these were males. The majority required application of vascular clamp at the junction of IVC with right atrium (RA), however, 21 patients required cardiopulmonary bypass (CPB) (29–193 min, mean 131 min). Hypothermic circulatory arrest (HCA) (12–42 min, mean 26 min) was used in 17 patients. The 30-day mortality was 6% (four patients) with no death in the elective CPB group. At a mean follow-up of 31 months, the overall two- and five-year survival rates were 50% and 37%, respectively. Cox regression revealed presence of metastasis (Odds ratio (OR) 3.1, 95% CI 1.2–8.2) and age >70 years (OR 2.9, 95% CI 1.3–6.3) adversely affected the long-term outcome. The management of RCC with IVC involvement is evolving for this complex group of patients. A multidisciplinary approach in selected patients is associated with good short- and long-term results.

Key Words: Renal cell carcinoma; Caval extension; Cardiopulmonary bypass; Hypothermia

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