Surgical Tumor Resection and Reconstruction of the Inferior vena cava under Cardiopulmonary Bypass for Right Renal Cell Carcinoma Extending into the Right Ventricle / 日本心臓血管外科学会雑誌

ABSTRACT

In cases of renal cell carcinoma causing embolism in the inferior vena cava, aggressive surgical resection is recommended and expected to improve the prognosis. The patient was a 52-year-old man who had been on hemodialysis since the age of 45 due to diabetic nephropathy. A CT scan for anemia revealed a tumor in the right kidney, and the patient was referred to the urologist at our hospital. A thorough examination revealed a diagnosis of primary right renal carcinoma with tumor embolization in the inferior vena cava (IVC) that extended to the right ventricle. During surgical resection of the tumor, a midline abdominal incision was made. The liver was detached and exposed to the IVC by the gastroenterological surgeon, followed by dissection of the right kidney for removal by the urologist. The wound was then extended to the anterior chest, and a mid-thoracic incision was made. The SVC was snared, and a right atrial incision revealed a tumor. We resected the tumor at the level of the diaphragm while blocking the IVC, and sutured the right atrium. The IVC was then incised centrally from the confluence of the right renal veins to identify the renal tumor that was resected from the lumen along with the venous wall. The missing IVC wall was reconstructed with an expanded polytetrafluoroethylene (ePTFE) patch. In this case, the patient received complete resection of a right renal cell carcinoma, with inferior vena cava embolism and tumor extending into the right ventricle, using extracorporeal circulation. He was discharged on the 29th day after surgery without any major postoperative complications. The use of cardiopulmonary bypass is considered to be an effective means of ensuring surgical safety in cases of complete resection of malignant tumors that have spread from the IVC to the heart.