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J Thorac Cardiovasc Surg 2006;131:1289-1295
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Contemporary techniques and safety of cardiovascular procedures in the surgical management of renal cell carcinoma with tumor thrombus

^a Departments of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex
^b Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex
^d Department of Radiology, Division of Interventional Radiology, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex
^e Department of Internal Medicine, Division of Hematology-Oncology, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex
^c Department of Thoracic Surgery, Kirikkale University, Kirikkale, Turkey

Received for publication October 24, 2005; revisions received January 3, 2006; accepted for publication January 13, 2006.

^_* Address for reprints: J. Michael DiMaio, MD, FACS, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390 (Email: michael.dimaio{at}utsouthwestern.edu).

OBJECTIVE: Renal cell carcinomas often form venous thrombi that extend into the vena cava. Frequently, cardiovascular consultation is necessary for complete surgical excision. We sought to investigate the risk factors, surgical techniques, and outcomes of patients treated for renal cell carcinoma with venous extension.

METHODS: We reviewed the records of 46 consecutive patients who underwent surgical management of renal cell carcinoma with venous extension between 1991 and 2005. Data on patient history, staging, surgical techniques, morbidity, and survival were analyzed.

RESULTS: There were 29 men and 17 women with a mean age of 60.2 ± 12.0 years. Twenty-five (54%) procedures were completed with cardiovascular assistance. Nephrectomy was performed in 44 (96%) cases. Three (7%) patients underwent right heart venovenous bypass, and 2 (5%) patients underwent cardiopulmonary bypass with circulatory arrest. Fourteen (32%) patients had perioperative complications, including 1 (2%) perioperative death. Patients who required cardiovascular procedures (inferior vena cava clamping, right heart venovenous bypass, and cardiopulmonary bypass with circulatory arrest) had higher risks of perioperative complications (P < .02). The 1-, 2-, and 5-year overall survival rates were 78%, 69%, and 56%.

CONCLUSIONS: This large series demonstrates that aggressive treatment of renal cell carcinoma with venous thrombus provides favorable outcomes. Our 5-year survival is among the highest of recent reviews, and our perioperative morbidity and mortality rates are comparable with those of other series. Tumors that require cardiovascular procedures are associated with increased complications when compared with radical nephrectomy and thrombectomy alone. Nevertheless, this aggressive treatment approach offers encouraging patient survival.