Surgery for cavoatrial extension of malignant tumors.

Surgical management for cavoatrial involvement of malignant tumors and its outcome is reported on for 6 patients; their age ranged from 55 to 79 years and 5 were male and 1 female. The basic disease was renal cell carcinoma in 5 cases and adrenal leiomyosarcoma in 1. Intracaval tumor extension was diagnosed by computed tomography, magnet resonance imaging, digital subtraction angiography, and echocardiography. The tumor was resected together with adherant vena cava and invaded right-atrial wall, using cardiopulmonary bypass and normo- or mild-hypothermia in 5 patients. The caval defect needed to be reconstructed with a slit GORE-TEX vascular prosthesis in 3 patients. In all patients the tumor resections were successful and without major complications. All patients survived and are well from 4 to 52 months after the surgery. It is concluded that such cavoatrial extensions of malignant tumors can be safely and accurately resected with the aid of cardiopulmonary bypass, with favorable early and late outcomes in patients who have no distant metastatic lesions.