Introduction and Objectives
Renal cancer in T3c stage is deadly hazardous for a patient becouse of its malignant potential and on the other side risk of pulmonary embolism caused by part of thrombus. Objectives: The aim of our study was to asses survival time in patients with renal cell carcinonoma in T3c clinical stage with thrombus in vena cava inferior extending up to the right atrium, treated by uro-cardiosurgery team by use special safety procedures such as: cardiopulmonary by-pass, profound hypothermia, circulatory arrest.
Material and Methods
This group consisted of nineteen patients, aged from 43 to 75, the average age was 59. Fourteen patients had right kidney tumor, five the left kidney tumor, and tumor thrombus extension into the right atrium. In all cases the patients didn’t have lymph node and distant metastases. None of patients had vena caval involvement symptoms like lower extremity edema, varicocele, dilated superficial abdominal veins, proteinuria and pulmonary embolism. In all patients CT scanning, abdominal ultrasound examination, contrast inferior venacavography, urography and ECHO were required before surgery. Patients were qulified to the procedure by urologist, anesthesiologist and cardiosurgeon. All patients underwent radical nephrectomy and vena caval thrombectomy. We used Robert Krane method:removal of Renal Cell Carcinoma extending into the right atrium, with opening thorax, using cardiopulmonary by-pass, profound hypothermia and circulatory arrest.
In august 2008 we have contacted with patients or their families. For past 6 years, 20 patients were operated, 11 (55%) of them died (including two patients who died in postooperative period), average time to death was 19 months, 9 (45%) patients still alive, average survival time is 41 months. The longest survival time is 75 months. Two patient, mentioned before, died in postoperative period as a result of sever, massive pulmonary embolism.There were no operative deaths.
The specific operative strategy used in these patients appear to provide a survival benefit and prevent pulmonary embolism. In patients with atrial tumor thrombus distant metastases uro-cardiosurgical procedure present possibility of prolonged survival. We were planning to change indications to this procedure, because our results and new possibilities of the adjuvant chemioterapy.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.