| Purpose: Report the experience of the radical surgery of renal cell carcinoma (RCC) with tumor thrombus extending into the inferior vena cava (IVC) and the right atrium (RA).Surgical technique: Our department of Urology had a patient with right renal cell carcinoma (RCC) with tumor thrombus extending into the inferior vena cava (IVC) and the right atrium (RA) in Feb, 2002. With the help of cardiac surgical team and anaesthetist, we successfully performed the radical nephrectomy and removed tumor thrombus by opening the IVC and the right atrium, with cardiopulmonary bypass (CPB) and superficial hypothermic circulatory arrest (the temperature of 34. 0℃).Results:1. Pathological results:Tumor was above pelvis, with the size of 4.5cmx3.5cmx2.5cm,invading pelvis. Tumor thrombus extended into the inferior vena cava. Paraaortic lymph nodes were normal. Pathological diagnosis indicated a usual type RCC with tumor thrombus of the IVC and the right atrium. 2. Treatment results:Surgery was successful.Two days later, the edema of lower limbs disappeared. The postoperative hospital stay was 18 days. Ultrasonography of the abdomen, and chest radiograph were normal when the patient left hospital. After eighteen months following surgery, the patient's conditions were well. Chest radiograph and Ultrasonography of the abdomen were normal again. Conclusion:1. Patients, who are found to have distant metastasis or regional lymph node metastasis, are not considered for aggressive surgery. For patients of RCC with the IVC and the right atrium involved by tumor thrombus without distant metastasis or regional lymph node metastasis, surgery is necessary.2. But conventional surgical techniques are hard to achieve complete resection, with high incidences of perioperative mortality and embolization of tumor thrombus. Techniques of CPB and HCA make surgery more effective and safe, improvimg survival time of patients.
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