Surgery for Cavoatrial Extension of Malignant Tumors

Abstract

Surgical management for cavoatrial involvement of malignant tumors and its outcome is reported on for 6 patients; their age ranged from 55 to 79 years and 5 were male and 1 female. The basic disease was renal cell carcinoma in 5 cases and adrenal leiomyosarcoma in 1. Intracaval tumor extension was diagnosed by computed tomography, magnet resonance imaging, digital subtraction angiography, and echocardiography. The tumor was resected together with adherant vena cava and invaded right-atrial wall, using cardiopulmonary bypass and normo- or mild-hypothermia in 5 patients. The caval defect needed to be reconstructed with a slit GORE-TEX vascular prosthesis in 3 patients. In all patients the tumor resections were successful and without major complications. All patients survived and are well from 4 to 52 months after the surgery. It is concluded that such cavoatrial extensions of malignant tumors can be safely and accurately resected with the aid of cardiopulmonary bypass, with favorable early and late outcomes in patients who have no distant metastatic lesions.

Challenges in the diagnosis of the enigmatic primary adrenal leiomyosarcoma: two case reports and review of the literature

“…[ 45 ] 1995 30 M Pain (abdominal) L 11 ND Operative pathology SMA Adrenalectomy Alive 20 Hayashi J. [ 46 ] 1995 55 F Pain (abdominal) and fever R ND IVC, hepatic vein and right atrium Operative pathology ND Adrenalectomy + nephrectomy Alive 52 Lack EE. [ 3 ] 1991 49 M Pain (flank) R 11 None Operative pathology SMA, vimentin and actin Adrenalectomy + nephrectomy, chemotherapy and radiation Alive 9 Choi SH.…”

Anesthetic management of renal cavoatrial tumor thrombus during partial cardiopulmonary bypass

“…It has been reported that cavoatrial thrombosis occurs in approximately 6% of patients with RCC. [1] The classification of caval thrombi in RCC is as follows: Level 1, venous thrombus in the renal vein that does not extended to the IVC; Level 2, infrahepatic IVC thrombus; Level 3, retro-or suprahepatic thrombus that does not reach the right atrium; and Level 4, thrombus in the right atrium. [8] All RCCs with a thrombus in the IVC and without metastasis require surgery.…”

“…It has been reported that cavoatrial thrombi occur in approximately 6% of patients with a renal-cell carcinoma (RCC). [1] Although cavoatrial thrombi may occur in renal tumors, the absence of distant metastases still allows radical surgery techniques to be employed. In the surgical treatment of patients with renal tumors and caval thrombi at multiple levels, cardiopulmonary bypass (CPB) with or without hypothermic circulatory arrest is used.…”

Inferior Vena Cava Resection and Hemihepatectomy for Leiomyosarcoma, Utilizing Cardiopulmonary Bypass, in Situ Hepatic Perfusion, and Distal Hypothermic Circulatory Arrest

“…6 Multiple authors have described resection of similar lesions using total body deep hypothermic circulatory arrest (DHCA). [7][8][9][10][11] Other authors have utilized cardiopulmonary bypass without DHCA. 12 In this case, 2 novel techniques were employed.…”