One-stage management of renal tumor with supraphrenic caval vein thrombus and coronary artery disease

136 One-stage management of renal tumor with supraphrenic caval vein thrombus and coronary artery disease Gronostaj K., Golabek T., Czech A.K., Wiatr T., Chlosta P.L. Jagiellonian University Medical College, Dept. of Urology, Cracow, Poland INTRODUCTION & OBJECTIVES: Surgical treatment of renal tumors with concomitant level IV caval vein thrombus requires interdisciplinary approach using hypothermic circulatory arrest. The number of patients with simultaneous critical coronary artery disease (CAD) and resectable tumors is rising with the increasing proportion of elderly people in the population. Therefore, in case of combination of both CAD and renal tumor with inferior vena cava (IVC) supraphenic thrombus a one stage surgery should be considered. The objectives are to assess the outcomes of simultaneous management of renal tumor with supraphrenic caval vein thrombus and coronary disease. MATERIAL & METHODS: We present a case of 58-year old male who complained of dull upper quadrant abdominal pain, fatigue, weight loss and dyspnea due to right kidney tumor with neoplastic thrombus in IVC. The CT showed a polycystic contrast enhancing upper pole renal mass measuring 5,6x6,2x6,7cm, invading right hepatic lobe and ipsilateral suprarenal gland, with thrombus in IVC. Coronarography revealed severe coronary artery disease. One-stage procedure was decided by the interdisciplinary team of urologists and cardiothoracic surgeons. The patient underwent right nephrectomy, cavotomy and thrombus removal with double coronary artery bypass grafts. RESULTS: Operative time was 400min. Blood loss was 2800cc. On the postoperative day one, the patient was reoperated due to abdominal bleeding. Intraoperatively an injury of hepatic capsule was discovered and repaired. 8 units of red blood cell concentrate were transfused perioperatively. The further postoperative course was uneventful. Histopathological examination of the specimen showed Fuhrman grade 2 renal clear cell carcinoma (RCC). The patient was discharged home on the twentyfourth post-operative day. Six month after the surgery CT scans showed no signs of recurrence. CONCLUSIONS: Morbidity and mortality risk in simultaneous coronary artery bypass grafts for CAD and nephrectomy, cavotomy and thrombus removal for RCC cannot be disregarded. There is no simple way to asses that risk for a combined procedure. However, the interdisciplinary approach seems to be the only feasible therapeutic option for patients with concomitant diseases to achieve satisfactory clinical and oncologic outcome. Eur Urol Suppl 2015; 14(6): e1295