AUTHOR=Zacek Pavel , Brodak Milos , Gofus Jan , Dominik Jan , Moravek Petr , Louda Miroslav , Podhola Miroslav , Vojacek Jan 

TITLE=Renal cell carcinoma with intracardiac tumor thrombus extension: Radical surgery yields 2 years of postoperative survival in a single-center study over a period of 30 years

JOURNAL=Frontiers in Oncology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1137804

DOI=10.3389/fonc.2023.1137804

ISSN=2234-943X

ABSTRACT=Background
Renal cell carcinoma (RCC) with tumor thrombus extension into the right atrium (level IV) is a rare life-threatening clinical condition that can only be managed by means of a combined urological and cardiac surgical approach. Early and late outcomes of this radical treatment were analyzed in a large single-institution series over a period of 30 years.

Methods
In 37 patients with RCC and intracardiac tumor thrombus extension, a nephrectomy was performed followed by extraction of the intracaval and intracardiac tumor thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). Recently, in 13 patients a selective aortic arch perfusion (SAAP) was instituted during DHCA.

Results
In all patients, precise removal of tumor thrombus was accomplished in a bloodless field. Mean duration of isolated DHCA was 15 ± 6 min, and 31.5 ± 10.2 min in case of DHCA+SAAP, at a mean hypothermia of 22.7 ± 4°C. In-hospital mortality was 7.9% (3 patients). In Kaplan-Meier analysis, estimated median survival was 26.4 months whereas 5-year cancer-related survival rate was 51 %.

Conclusions
Despite its complexity, this extensive procedure can be performed safely with generally uneventful postoperative course. The use of cardiopulmonary bypass with DHCA, with the advantage of SAAP, allows for a safe, precise and complete extirpation of intracaval and intracardiac tumor mass. Late outcomes after radical surgical treatment in patients with renal cell carcinoma and tumor thrombus reaching up in the right atrium in our series justify this extensive procedure.