Dedeilias Panagiotis, Koletsis Efstratios, Rousakis Antonios G, Kouerinis Ilias, Zaragkas Stylianos, Grigorakis Alkis, Leivaditis Vassilios, Malovrouvas Dimitrios, Apostolakis Efstratios
1st Cardiac Surgery Department, Evangelismos General Hospital, Athens, Greece.
J Card Surg. 2009 Nov-Dec;24(6):617-23. doi: 10.1111/j.1540-8191.2009.00887.x. Epub 2009 Sep 2.
The inferior vena cava (IVC) is involved in almost 5% to 10% of renal tumors. Their intraluminar extension to the cardiac cavities occurs with a tumor-thrombus formation at a percentage of 1%. The aim of this study is to present the principles of "radical" management that should be targeted to excision of the kidney together with the cavoatrial tumor-thrombus.
From 2003 through 2008, we treated six patients with renal-cell carcinoma involving the IVC and/or the right cardiac chambers. The main symptoms leading to the diagnosis were hematuria, dyspnea, or lower limb edema. The extension of the tumor was type IV in three cases, type III in two, and type II in one case.
Extracorporeal circulation combined with a short period of hypothermic circulatory arrest was the method used. Radical nephrectomy combined with cavotomy and atriotomy was performed to an "en-block" extirpation of the tumor-thrombus and allowed oncologic surgical clearance of the disease.
There was no operative death. The mean postoperative course duration was 11 days, apart from one obese patient who presented postoperative pancreatitis and died on the 44th postoperative day due to respiratory failure. During the cumulative postoperative follow-up of 171 months the patients remain free of recurrence.
The use of extracorporeal circulation and deep hypothermic circulatory arrest provides a good method for radical excision of renal carcinomas involving the IVC with satisfactory morbidity and long-term survival results. Cooperation of urologists and cardiac surgeons is necessary for this type of operation.
下腔静脉（IVC）受累于近5%至10%的肾肿瘤。肿瘤向心腔内的管腔内延伸并形成肿瘤血栓的发生率为1%。本研究的目的是阐述针对肾肿瘤合并腔房肿瘤血栓切除的“根治性”治疗原则。
2003年至2008年，我们治疗了6例累及下腔静脉和/或右心腔的肾细胞癌患者。导致诊断的主要症状为血尿、呼吸困难或下肢水肿。肿瘤分期为IV型3例，III型2例，II型1例。
采用体外循环联合短时间低温循环停止的方法。行根治性肾切除术联合腔静脉切开术和心房切开术，“整块”切除肿瘤血栓，实现肿瘤的肿瘤学手术清除。
无手术死亡。术后平均病程为11天，1例肥胖患者术后出现胰腺炎，术后第44天因呼吸衰竭死亡。在术后累计随访171个月期间，患者无复发。
体外循环和深度低温循环停止的应用为根治性切除累及下腔静脉的肾癌提供了一种良好的方法，其发病率和长期生存结果令人满意。对于此类手术，泌尿外科医生和心脏外科医生的合作是必要的。
