Key result
Emergency CPB and pulmonary thrombectomy rescue cardiac arrest from massive intraoperative tumor embolism without neurological sequelae.
Why the study?
Intraoperative tumor thrombus embolization during renal cell carcinoma surgery with inferior vena cava tumor thrombus is a rare but potentially fatal complication.
Case Report (n=1)
No
Highlights the critical importance of preoperative risk assessment, intraoperative TEE monitoring, and immediate multidisciplinary emergency cardiopulmonary bypass to manage massive intraoperative pulmonary tumor embolism.
May inform emergency bypass preparedness in high-risk RCC surgery with IVC thrombus; hypothesis-generating and leaves optimal monitoring open.
Introduction Intraoperative tumor thrombus embolization during renal cell carcinoma (RCC) surgery with inferior vena cava (IVC) tumor thrombus is a rare but potentially fatal complication. We report successful emergency cardiac surgery for massive pulmonary artery tumor embolism. Case Presentation A 75‐year‐old female with left RCC and IVC tumor thrombus underwent radical nephrectomy. Pre‐existing left pulmonary artery tumor embolism was noted preoperatively. During IVC manipulation, the tumor thrombus dislodged and migrated through the right heart to completely occlude the right pulmonary artery, causing cardiac arrest. Through multidisciplinary collaboration, nephrectomy was completed under cardiac massage, followed by emergency cardiopulmonary bypass and pulmonary artery thrombectomy. The patient recovered completely without neurological sequelae. Conclusion This case demonstrates the critical importance of preoperative risk assessment, intraoperative transesophageal echocardiography monitoring, and immediate multidisciplinary decision‐making in managing this life‐threatening complication. The “double hit” mechanism of pre‐existing and acute pulmonary embolism significantly worsened the clinical course.
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Kijima et al. (2026) conducted a case report in Renal cell carcinoma with inferior vena cava tumor thrombus and pre-existing pulmonary artery tumor embolism (n=1). Emergency cardiopulmonary bypass and pulmonary artery thrombectomy was evaluated on Survival and neurological recovery after cardiac arrest. Emergency cardiopulmonary bypass and pulmonary artery thrombectomy successfully rescued the patient without neurological sequelae following cardiac arrest caused by intraoperative massive pulmonary tumor embolism.
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