Long-term survival after radical surgery for renal cell carcinoma with tumour thrombus extension into the right atrium.

What's known on the subject? and What does the study add? Surgical treatment of renal cell carcinoma (RCC) with tumour thrombus extending into the right atrium remains, despite its complexity and specific technical aspects, the only radical therapeutic option. This single-centre study, unique in size for this rare condition, reports early and late results over a period of 18 years. All patients were operated on using a standardised protocol with use of cardiopulmonary bypass and deep hypothermic circulatory arrest. Overall and cancer-specific cumulative survival was better than in other reports. OBJECTIVE center dot To evaluate the long-term results of radical surgical management of renal cell carcinoma (RCC) with tumour thrombus extension (TTE) level IV into the right atrium (RCC/TTE IV) in a large single-institution series. PATIENTS AND METHODS center dot Radical complex urological and cardio-surgical procedure was performed over a period of 18 years (19932010) on 21 patients with RCC/TTE IV. A radical nephrectomy was performed followed by sternotomy, institution of cardiopulmonary bypass and extraction of the intracardiac tumour thrombus under direct visual control during deep hypothermic circulatory arrest (DHCA). center dot Perioperative and postoperative variables, and long-term overall and cancer-specific survival using the KaplanMeier method were analysed. RESULTS center dot In all patients, precise removal of tumour thrombus was accomplished in a bloodless field during DHCA. center dot The mean (sd) duration of circulatory arrest was 16 (6) min at a mean hypothermia of 20 (3) degrees C. In-hospital mortality was 9.5% (two patients). center dot The median survival (including in-hospital mortality) was 25 months. center dot In KaplanMeier analysis, 2- and 5-year overall cumulative survival rate was 57 (95% confidence interval, CI 3678)% and 37 (95% CI 1558)%, respectively. center dot Cancer-specific cumulative survival was 68 (95% CI 4989)% at 2 years and 51 (95% CI 2874)% at 5 years. CONCLUSIONS center dot Late outcome after radical surgical treatment in patients with RCC and TTE reaching up to the right atrium justifies this extensive procedure. center dot Cardiopulmonary bypass with DHCA allows safe and precise extirpation of all intracaval and intracardiac tumour mass.