Key result
Transabdominal approach permits safe supradiaphragmatic RCC tumor thrombus resection without sternotomy or CPB.
Why the study?
Current techniques for resection of supradiaphragmatic RCC tumor thrombus in the IVC require cardiopulmonary bypass with deep hypothermic circulatory arrest, especially when the thrombus reaches the right atrium.
Case Report
A transabdominal approach can safely allow resection of supradiaphragmatic RCC tumor thrombi extending into the IVC and right atrium without the need for sternotomy or cardiopulmonary bypass.
Should not yet alter surgical planning for supradiaphragmatic RCC thrombus; leaves open the role of transabdominal approaches pending prospective validation.
Renal cell carcinoma (RCC) is a commonly encountered malignancy in urology. Extensive RCC may frequently invade the renal vein and the inferior vena cava (IVC). In advanced cases, this tumor thrombus may grow cephalad up to the level of the right atrium. The mainstay of surgical treatment for such lesions remains resection of all possible tumor burden. Current techniques for resection of supradiaphragmatic RCC tumor thrombus in the IVC incorporate cardiopulmonary bypass (CBP) with deep hypothermic circulatory arrest, especially in cases where the thrombus reaches the right atrium. We report a safe technique using a transabdominal approach to such lesions that allows exposure to the level of the intrapericardial IVC and right atrium permitting safe resection of the tumor thrombus without median sternotomy, CBP, or deep hypothermic circulatory arrest.
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Ciancio et al. (2009) conducted a case report in Renal cell carcinoma with vena caval tumor thrombus extension above the diaphragm. Transabdominal approach for resection of supradiaphragmatic RCC tumor thrombus vs. Cardiopulmonary bypass with deep hypothermic circulatory arrest (historical/current standard) was evaluated. A transabdominal approach allows exposure to the intrapericardial IVC and right atrium, permitting safe resection of supradiaphragmatic RCC tumor thrombus without sternotomy or cardiopulmonary bypass.
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