Extension of renal cell carcinoma into the vena cava with concomitant coronary artery disease: surgical considerations.

Surgical removal of renal cell carcinoma with extension into the inferior vena cava can be a difficult operation. Cardiopulmonary bypass and circulatory arrest have been used to assist in resection of tumors that extend into the vena cava above the level of the hepatic veins. Coronary artery disease is a common problem and may present together with renal cell tumors. A patient with left main coronary artery disease and a renal cell carcinoma extending into the vena cava provides a management challenge. We present such a case and discuss the surgical options.