[Interdisciplinary surgical therapy of renal tumors with intracardiac tumor thrombi]. / Interdisziplinäre operative Therapie der renalen Tumoren mit intrakardialen Tumorthromben.

ABSTRACT

A combination of increased perioperative morbidity, together with the technical difficulty of an R 0 (curative) resection, is responsible for the poor prognostic factors of supradiaphragmatically extending renal tumors. Six patients aged 53-70 years with vena cava thrombosis extending into the right atrium or ventricle underwent en bloc resection of the primary tumor and tumor thrombus removal. If the atrial tumor mass was large or extended into the ventricle, resection was performed during cardiopulmonary arrest using a cardiopulmonary bypass method with the patient in deep hypothermia (< 18 degrees C). Alternatively if the cardiac tumor infiltration was minimal, resection was performed during an optionally short cardiopulmonary arrest period using a cardiopulmonary bypass method with the patient in hypothermia (23 degrees C). The operative procedure was determined by intracardiac tumor extension, tumor wall adhesions and tumor wall infiltrations, all of which were assessed intraoperatively by vena cava sonography. Six patients were strongly symptomatic preoperatively. Three developed sudden life-threatening cardiopulmonary insufficiency, possibly due to longer-lasting tricuspital valve prolapse with a consecutive right-to-left shunt through a newly reopened foramen ovale. One patient died 14 months postoperatively because of multiple metastases (hepatic, pulmonary and bone). One patient is still alive and has had a local recurrence for 2 months, which was diagnosed 65 months postoperatively. The remaining four patients are alive and well. They have been tumor-free for extended periods of time (29, 34, 62 and 84 months, respectively).