[HSF] Renal cell ca

Mon Jun 4 15:49:40 EDT 2007

"and I said that regardless of the stage, clearly tumor out of the
heart/IVC would have significant palliative benefits?"

Clearly a valid argument.

NFA

On 6/4/07, Michael Firstenberg <msfirst at gmail.com> wrote:
>
> For once I agree with Tomas about off-pump!
> We typically dont even get consulted (although the vascular guys do)
> unless
> the tumor is actually into the right atrium/heart.
>
> Too bad since these are fun cases.
> Which bring up another question - I got into a discussion with someone
> about
> resecting these even if the tumor extends out of Gerota's fascia.  They
> said
> no since it is already advanced disease (although I thought caval
> involvement was already stage IV by definition - but will have to look it
> up) and I said that regardless of the stage, clearly tumor out of the
> heart/IVC would have significant palliative benefits?
>
>
> -michael
>
>
> On 6/4/07, Salerno, Tomas <TSalerno at med.miami.edu> wrote:
> >
> > Cerwicka WH, Ciancio G, Salerno TA, Soloway M: Renal cell cancer with
> > invasive atrial tumor thrombus excised off pump. Urology 2005; 66: 11318
> >
> >
> > Tomas
> >
> > -----Original Message-----
> > From: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of A
> > Sent: Monday, June 04, 2007 5:45 PM
> > To: OpenHeart-L at lists.hsforum.com
> > Subject: RE: [HSF] Renal cell ca
> >
> > Dr. Salerno
> >
> > Citation please for the reference Thanks
> >
> > Ahmed
> >
> > -----Original Message-----
> > From: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Salerno,
> > Tomas
> > Sent: Monday, June 04, 2007 4:33 AM
> > To: OpenHeart-L at lists.hsforum.com
> > Subject: RE: [HSF] Renal cell ca
> >
> > Gaetano Ciancio and I have reported this operation without the use of
> > the heart lung machine. Urology 2005; 66: 1318.  These were rather
> > extensive tumors, some of them appearing into the RA. We were able to
> > mobilize the liver off the vena cava, open the diaphragm, and apply a
> > clamp into the RA so as to exclude the tumor, thereby avoid
> > cardiopulmonary bypass and without opening the chest.
> >
> > Tomas
> >
> > -----Original Message-----
> > From: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of A
> > Sent: Monday, June 04, 2007 5:05 PM
> > To: OpenHeart-L at lists.hsforum.com
> > Subject: RE: [HSF] Renal cell ca
> >
> > Thanks Michael good point I will remember that
> >
> > Ahmed
> >
> > -----Original Message-----
> > From: openheart-l-bounces at lists.hsforum.com
> > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Michael
> > Firstenberg
> > Sent: Monday, June 04, 2007 3:58 AM
> > To: OpenHeart-L at lists.hsforum.com
> > Subject: Re: [HSF] Renal cell ca
> >
> > The few of these that I have done, I have put the venous line in the
> > IVC,
> > below the renal veins.  It is exposed very nicely by the urologists and
> > it
> > is sitting right there - and avoids going into a groin.  It also reminds
> > them to be careful and keeps them focused since you are on-pump.
> >
> >
> > -michael
> >
> >
> > On 6/4/07, A <alsadd at ksu.edu.sa> wrote:
> > >
> > > Jay:
> > > Interesting approach as we have an aggressive group of urologists we
> > may
> > > be
> > > called to one of these. My question where do you put venous line? Do
> > you
> > > only use the SVC and go bypass on one venous canula? Please clarify
> > > Thanks
> > >
> > > Ahmed
> > >
> > >
> > >
> > >
> > > On 5/31/07, Jacob Lavee, MD <jaylavee at netvision.net.il> wrote:
> > > >
> > > > Ed,
> > > > I've done 6 such cases together with our urologists and they were
> > all
> > > > successful. In all cases we've gone on pump following initial
> > abdominal
> > > > preparation by the urologists and cooled the patients down to deep
> > > > hypothermia. Once total circulatory arrest is initiated we've worked
> > in
> > > > parallel - me opening the RA and evacuating the tumor tissue from
> > the
> > > RV,
> > > RA
> > > > and down the IVC as far as I could get from inside the RA, while
> > they
> > > opened
> > > > the abdominal IVC and took out the rest of the tumor from below,
> > until
> > > both
> > > > our fingers could meet each others from inside the IVC. The rest of
> > the
> > > > operation is straight forward being completed by nephrectomy. In all
> > > these
> > > > cases the urologists blessed me for providing them a clean and
> > bloodless
> > > > environment to clean the entire IVC and sometimes even into the
> > iliacs.
> > > >
> > > > Jay Lavee
> > > >
> > > > From: Edward Bender
> > > > To: OpenHeart-L
> > > > Sent: Thursday, May 31, 2007 5:50 AM
> > > > Subject: [HSF] Renal cell ca
> > > >
> > > >
> > > > Here's tomorrow's interesting case.  60 year old insulin dependent
> > > > diabetic hypertensive smoking female with hematuria.  She has a
> > right
> > > > renal cell carcinoma with tumor thrombus.  I had her cathed and she
> > > > has normal coronaries.  Below are the relatively suboptimal CT scans
> > > > and echo.  I've never had to go on bypass to resect one of these,
> > but
> > > > this one may be different.  There is extensive thrombus extending
> > > > into the RV through the tricuspid valve.  There is retrograde
> > > > thrombus into the left renal vein and the distal IVC and iliac vein.
> > > > I plan on trying to pull this down from below, but will be ready to
> > > > go on bypass if needed.  Any words of wisdom?  Below are selected
> > > > pictures.
> > > >
> > > > Ed Bender, MD
> > > >
> > > >
> > > >
> > > >
> > > > __________ NOD32 2299 (20070530) Information __________
> > > >
> > > > This message was checked by NOD32 antivirus system.
> > > > http://www.eset.com
> > > >
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-- 
Nasser  F.  Abou'Seada,
MB,ChB,MD,FRCSEd,ChM,ChD C/Th,
FICS,FISCVS,FSSRCTS,FHMS,MESC