Key result
Simultaneous radical nephrectomy, inferior vena cava thrombectomy, and coronary artery bypass grafting was performed safely without complications or disease recurrence at 9 months.
Why the study?
Renal cell carcinoma with right atrial tumor thrombus combined with severe CAD is extremely rare, leaving a lack of applicable management recommendations.
Case Report (n=1)
No
Simultaneous coronary artery bypass grafting and radical nephrectomy with caval and atrial thrombectomy under cardiopulmonary bypass is feasible and safe in selected patients with renal cell carcinoma and severe coronary artery disease.
BACKGROUND: Renal cell carcinoma accounts for 2-3% of all malignant cancers in adults and is characterized by the potential development of venous tumor thrombus. CASE PRESENTATION: We present a rare case of a 62-year-old Caucasian man who arrived in the emergency department for monosymptomatic hematuria. Further investigation revealed a right renal cell carcinoma with 16 cm intravascular extension through the renal vein into the inferior vena cava and right atrium associated with significant coronary artery disease based on the computed tomography scan and coronary angiography. To the best of our knowledge, after an extensive literature review, only one similar case has been reported with involvement of the contralateral kidney. Therefore, there are no applicable management recommendations. After performing coronary artery bypass graft surgery, we proceeded with an open right radical nephrectomy and inferior vena cava and right atrium thrombectomy under cardiopulmonary bypass and while the patient's heart was still beating. The postoperative course went without complications, and the patient was discharged from the hospital on the 10th postoperative day. CONCLUSIONS: Radical nephrectomy and thrombectomy with reconstruction of the inferior vena cava combined with coronary artery bypass graft can be performed safely and effectively in selected patients with renal cell carcinoma and significant coronary artery disease. Multidisciplinary teamwork and careful patient selection are essential for optimal outcomes.
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Filomena et al. (2023) conducted a case report in Renal cell carcinoma with atrial thrombotic extension and severe chronic coronary artery disease (n=1). Simultaneous coronary artery bypass graft surgery, radical nephrectomy, and thrombectomy was evaluated on Clinical recovery and disease recurrence. Simultaneous radical nephrectomy, inferior vena cava thrombectomy, and coronary artery bypass grafting was performed safely without complications or disease recurrence at 9 months.
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