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J Thorac Cardiovasc Surg 2010;139:320-325
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Concomitant surgery for renal neoplasm with pulmonary tumor embolism

^a Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
^b Division of Urology, Mayo Clinic, Rochester, Minn

Received for publication February 12, 2009; revisions received April 4, 2009; accepted for publication April 23, 2009.

^_* Address for reprints: Christopher G. A. McGregor, MB, FRCS, MD(Hons) Professor of Surgery, Division of Cardiovascular Surgery, Mayo Clinic, 200 1st St SW, Rochester, MN 55905. (Email: mcgregor.christopher{at}mayo.edu).

Objective: Gross tumor pulmonary embolism from renal carcinoma is rarely diagnosed preoperatively. Individual cases of intraoperative embolization of tumor during radical resection of the kidney have been reported. We report on 9 patients who underwent pulmonary arterial tumor removal concomitant with nephrectomy.

Methods: Between 2000 and 2008, 9 patients underwent simultaneous nephrectomy and removal of gross embolic tumor from the pulmonary arteries. In 7 of these patients the diagnosis was made preoperatively by either computed tomography or magnetic resonance imaging. Cardiopulmonary bypass was used in all cases. Bilateral removal of pulmonary artery tumor was required in 7 patients and unilateral in 2.

Results: All patients survived to hospital discharge after a median stay of 8.8 days (mean, 6–17 days). Two patients are currently alive 4 and 56 months after the operation. Six patients died of distant metastasis or local recurrence of disease after 6, 9, 12, 17, 25, and 29 months. Actuarial survival at 6 months, 1, 2, and 3 years was 100%, 75%, 50%, and 25%, respectively.

Conclusions: Pulmonary artery embolic tumor removal concomitant with nephrectomy for renal carcinoma can be performed safely. Survival of patients with combined surgery is comparable with that of patients with the same stage of renal neoplasm without pulmonary tumor embolism. The pulmonary tumor embolism in patients with renal carcinoma should be considered as extension of vena caval tumor but not as a distant metastasis. Pulmonary tumor removal provides symptomatic relief and may provide a survival benefit in these patients.

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