Concomitant surgery for renal neoplasm with pulmonary tumor embolism

Nihan Kayalar, Bradley C. Leibovich, Thomas A. Orszulak, Hartzell V Schaff, Thoralf M. Sundt, Richard C. Daly, C. G A McGregor

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: Gross tumor pulmonary embolism from renal carcinoma is rarely diagnosed preoperatively. Individual cases of intraoperative embolization of tumor during radical resection of the kidney have been reported. We report on 9 patients who underwent pulmonary arterial tumor removal concomitant with nephrectomy. Methods: Between 2000 and 2008, 9 patients underwent simultaneous nephrectomy and removal of gross embolic tumor from the pulmonary arteries. In 7 of these patients the diagnosis was made preoperatively by either computed tomography or magnetic resonance imaging. Cardiopulmonary bypass was used in all cases. Bilateral removal of pulmonary artery tumor was required in 7 patients and unilateral in 2. Results: All patients survived to hospital discharge after a median stay of 8.8 days (mean, 6-17 days). Two patients are currently alive 4 and 56 months after the operation. Six patients died of distant metastasis or local recurrence of disease after 6, 9, 12, 17, 25, and 29 months. Actuarial survival at 6 months, 1, 2, and 3 years was 100%, 75%, 50%, and 25%, respectively. Conclusions: Pulmonary artery embolic tumor removal concomitant with nephrectomy for renal carcinoma can be performed safely. Survival of patients with combined surgery is comparable with that of patients with the same stage of renal neoplasm without pulmonary tumor embolism. The pulmonary tumor embolism in patients with renal carcinoma should be considered as extension of vena caval tumor but not as a distant metastasis. Pulmonary tumor removal provides symptomatic relief and may provide a survival benefit in these patients.

Original languageEnglish (US)
Pages (from-to)320-325
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume139
Issue number2
DOIs
StatePublished - Feb 2010

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Circulating Neoplastic Cells
Kidney Neoplasms
Pulmonary Embolism
Nephrectomy
Neoplasms
Pulmonary Artery
Kidney
Carcinoma
Survival
Neoplasm Metastasis
Lung
Venae Cavae
Cardiopulmonary Bypass
Tomography
Magnetic Resonance Imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Kayalar, N., Leibovich, B. C., Orszulak, T. A., Schaff, H. V., Sundt, T. M., Daly, R. C., & McGregor, C. G. A. (2010). Concomitant surgery for renal neoplasm with pulmonary tumor embolism. Journal of Thoracic and Cardiovascular Surgery, 139(2), 320-325. https://doi.org/10.1016/j.jtcvs.2009.04.021

Concomitant surgery for renal neoplasm with pulmonary tumor embolism. / Kayalar, Nihan; Leibovich, Bradley C.; Orszulak, Thomas A.; Schaff, Hartzell V; Sundt, Thoralf M.; Daly, Richard C.; McGregor, C. G A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 139, No. 2, 02.2010, p. 320-325.

Research output: Contribution to journalArticle

Kayalar, N, Leibovich, BC, Orszulak, TA, Schaff, HV, Sundt, TM, Daly, RC & McGregor, CGA 2010, 'Concomitant surgery for renal neoplasm with pulmonary tumor embolism', Journal of Thoracic and Cardiovascular Surgery, vol. 139, no. 2, pp. 320-325. https://doi.org/10.1016/j.jtcvs.2009.04.021
Kayalar, Nihan ; Leibovich, Bradley C. ; Orszulak, Thomas A. ; Schaff, Hartzell V ; Sundt, Thoralf M. ; Daly, Richard C. ; McGregor, C. G A. / Concomitant surgery for renal neoplasm with pulmonary tumor embolism. In: Journal of Thoracic and Cardiovascular Surgery. 2010 ; Vol. 139, No. 2. pp. 320-325.
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