Extracorporeal circulation for renal cell carcinoma with supradiaphragmatic caval thrombus

Removal of the tumor thrombus extended into the intrapericardial vena cava, was accomplished under direct vision with minimal blood loss in a patient with renal cell carcinoma. The liver was mobilized to expose the retrohepatic vena cava by incision of the falciform, triangular and coronary ligaments, and cardiopulmonary bypass was used to create a bloodless field avoiding the migration of tumor thrombus and uncontrollable hemorrhage. Tumor thrombus was delivered intact with a 20 Fr. Foley catheter. Vena cava surgery was done for the tumor invasion, and an artificial vascular graft was then sutured to replace the caval wall. We believe that this technique can be effectively used in selected patients with extensive intracaval involvement of renal cancer.