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View of intracaval/intracardiac tumor being removed throughthe open atrium during cardiopulmonary bypass.
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In a rare case of locally advanced renal
carcinoma that included
involvement of the entire
vena cava and extended
into the right atrium, a
multidisciplinary team of
physicians in disciplines
including interventional
radiology, cardiology,
cardiac surgery, vascular
surgery, urology,
oncology, and general
surgery recently excised
a mammoth tumor.
“I’ve seen a handful of
these tumors in my career,
but never one this large,”
said Ravindra Karanam, MD,
cardiothoracic surgeon at Newark Beth
Israel Medical Center, who, in addition to
removing a lemon-sized mass from the right
atrium and clearing the complete
obstruction of the inferior vena cava, also
closed the patient’s patent foramen ovale. “Other tertiary care hospitals in the state
turned the case down, saying it was too
risky,” he added.
“What made this case so challenging was
the need for highly expert and coordinated
care,” said Indu Sabnani, MD, oncologist.“This is a young and otherwise healthy
person. Prognosis is excellent in this case
due to the successful surgery and the
availability of numerous novel treatment
options.”
The tumor had a tremendous blood supply.
To reduce the risk of hemorrhage, 24 hours
prior to surgery the affected kidney and the
football-sized tumor that engulfed it were
embolized in the interventional radiology
suite. “Most threatening was the risk of
pulmonary or cerebral emboli
resulting from the many blood clots
that had formed on the surface of the tumor in the heart,” noted Dr. Karanam.
In a Newark Beth Israel Medical Center OR, over a period of nine and a half hours on a Saturday, a team of 11 physicians performed a highly complex right radical nephrectomy with removal of tumor and thrombus from the heart and vena cava.“Usually we take these tumors out in one piece, but because of the extraordinary size we operated in the chest and abdomen simultaneously,” explained Bruce Brener, MD, Director of the Vascular Center of the Saint Barnabas Health Care System. “The challenge was controlling the bleeding from the vena cava.” Common bile duct repair was also necessary after removal of the invading tumor.
“In this era of targeted therapy forrenal cell carcinoma, I am veryoptimistic for the patient,” said Dr. Sabnani.
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Intracaval tumor being excised through
venotomy. |
Trevor Atherley, MD, Cardiology
Kamalakar Ayyagari, MD, GeneralSurgery
Bruce Brener, MD, Vascular Surgery
Cindy Sturt, MD, Vascular Surgery
Chunguan Chen, MD, Cardiac Imaging
Ravindra Karanam, MD, Cardiothoracic Surgery
Luke Lin, MD, Anesthesiology
Prakash Paragi, MD, General Surgery
Indu Sabnani, MD, Oncology
Suken Shah, MD, InterventionalRadiology
Alan Strumeyer, MD, Urology
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