Introduction: We describe a multidisciplinary approach for treating patients with tumors invading the right atrium by direct extension through the inferior vena cava (IVC). Radical nephrectomy and inferior vena cavotomy with the removal of tumor and thrombus offer the best hope of long-term survival for carcinomas extending into the renal vein, the IVC, and up to the right atrium.
Methods: We retrospectively reviewed our experience of 10 patients with either renal cell or adrenocortical carcinomas with direct (level III or level IV) extension. All cases were operated by a multidisciplinary team involving Cardiac Surgeons, Urologists, and Vascular Surgeons. Of the 10 patients, 5 required extracorporeal circulation. Through a median sternotomy approach, the right atrium was opened on a beating heart and the tumor was extracted completely from the right atrium and the supra-diaphragmatic IVC. Next, the IVC was occluded above the diaphragm and the abdomen was accessed through a Chevron incision. Either the kidney or the suprarenal gland was removed and the tumor extension was removed from the inferior vena cava below the diaphragm. No IVC resection was performed.
Results: In all 10 patients (mean age, 61±24 years), complete removal of the tumor and its extension was accomplished. No postoperative mortality was reported. Operative time varied between 233-447 min (mean, 331min), and average CPB time was 125min. Patients required 4 packed blood cell units on average during the operation and 1.3 units during ICU stay. No major complications occurred postoperatively (including, acute renal failure, postoperative atrial fibrillation, cerebrovascular accidents, myocardial infarction, liver failure).
Conclusions: Surgical treatment of retroperitoneal carcinomas extending into the right atrium is feasible and with a good short term outcome. A multidisciplinary approach is advised to accomplish such a procedure with minimal complications.
