Simplified Cardiopulmonary Bypass Technique for the Surgical Treatment of Renal Tumors with Intracaval and Intracardiac Extensions

The authors report four cases of renal tumors with intracaval and intracardiac extensions that can be removed successfully during cardiopulmonary bypass surgery. The management was relatively simple: mild hypothermia, empty heartbeat, monocaval cannulation, and no circulatory arrest. Bleeding from the hepatic or renal veins was controlled by temporary occlusion of the hepatic artery, the portal vein, and the renal artery for a short duration. The authors also advocate thrombectomy of the hepatic vein using direct observation to relieve hepatic congestion. No complications were experienced postoperatively. One patient died of systemic metastasis 9 months after the operation. Another died of cytomegalovirus infection 3 months postoperatively. The remaining 2 are leading normal lives. Although the surgical indication for these advanced tumors is controversial, the patients' quality of life may be improved by this aggressive yet simple and safe approach.