Innovative Two-Stage Surgery for Renal Cell Carcinoma with Cardiac Tumor and Budd-Chiari Syndrome

What is it about?

The article describes a new technique for treating renal cell carcinoma with intra-cardiac tumor extension and Budd-Chiari syndrome. The first stage involves debulking of the right heart, inferior vena cava (IVC) and hepatic veins via median sternotomy, followed by a purse-string suture placed in the IVC below the hepatic veins. The second stage involves en bloc resection of the affected kidney, and IVC and vascular reconstruction via an abdominal incision. Five patients have undergone this procedure, and four of them had R0 resection. The second-stage procedure was generally well-tolerated, and all patients survived with no disease recurrence. The technique offers several advantages, including the ab initio manipulation of the tumor via a transdiaphragmatic approach, which allows for the safe removal of intra-cardiac and retro-hepatic tumor thrombus without physical manipulation of the liver itself, reducing the risk of mechanical obstruction of hepatic venous outflow intraoperatively.

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Why is it important?

This research is important because it presents a new technique for the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome. This technique involves a two-stage procedure that involves transdiaphragmatic debulking of the right heart, inferior vena cava (IVC), and hepatic veins via median sternotomy, followed by IVC resection and vascular reconstruction. The study shows that this technique is feasible and safe, with four of the five patients having a R0 resection and no disease recurrence in the surviving patients at the time of writing. This research can contribute to the development of a program for the surgical treatment of this type of cancer, which currently has high morbidity and mortality rates. Key Takeaways: 1. The study presents a new technique for the treatment of renal cell carcinoma with intra-cardiac tumour extension and Budd-Chiari syndrome involving a two-stage procedure. 2. The first stage involves transdiaphragmatic debulking of the right heart, inferior vena cava (IVC), and hepatic veins via median sternotomy, followed by a purse-string suture placed in the IVC below the hepatic veins. 3. The second stage is performed separately and involves en bloc resection of the affected kidney, and IVC and vascular reconstruction via an abdominal incision. 4. Four of the five patients had a R0 resection, and all survive with no disease recurrence at the time of writing. 5. The technique is feasible and safe, and supports the development of a program for the surgical treatment of this type of cancer.