Surgical treatment of kidney cancer patients with right atrial tumour thrombus at the University of Pécs, Department of Urology between 2010 and 2022
DOI: 10.22591/magyurol.2023.4.beresb.180
Authors:
Béres Bence dr., Szántó Árpád dr.
Pécsi Tudományegyetem KK, Urológiai Klinika, Pécs (igazgató: Szántó Árpád dr.)
Summary
Introduction: Introduction: A very distinctive but rare feature of renal cell tumours is that they may involve the right atrium beyond the level of the diaphragm following invasion of the renal vein and then the inferior vena cava. If the disease can be controlled locally, there is an absolute indication for surgery because of the threat of pulmonary embolization, but in case of poor general condition and disseminated disease with an unfavourable prognosis, surgical intervention is not beneficial.
Patients and methods: Data from patients with renal tumours who underwent radical nephrectomy and thrombectomy for thrombus of the right atrium were processed. The surgeries were performed at the Department of Cardiac Surgery of the University of Pécs, between January 2010 and December 2022, with the participation of cardiac surgeons, urologists and vascular surgeons. Seven patients had no detectable metastasis at the time of surgery, three cases were diagnosed as oligometastatic disease on the basis of imaging studies. All patients underwent transperitoneal radical nephrectomy with thoracotomy in extracorporal circulation.
Results: The average duration of the operations was 310 minutes (258–360), and the extracorporal circulation time was 39 minutes (21–84). During the interventions, we had to perform embolectomy for pulmonary embolization in 3 cases, and we also successfully managed 2 cases of ventricular fibrillation and 1 case of sudden cardiac arrest. During follow-up, we observed a better survival (39.7 months) in patients with no metastasis at surgery compared to patients with an oligometastatic disease at detection (22.8 months).