Performed by the multidisciplinary Urology and Cardiac Surgery team on a 65 year old patient. A very complex surgical operation which, to avoid bleeding, required blocking cardiac activity, while maintaining the blood flow to the other organs through extra-corporeal blood circulation
08 MAY – In recent days the Urology team of the Ao of Perugia, directed by prof. Ettore Mearini, together with the Cardiac Surgery team, directed by Dr. Marcello Bergonzini, they performed, for the first time in Umbria, a surgery to defeat a serious and rare case of kidney cancer that had spread to the heart.
The 65 year old Umbrian patient, transferred from the hospital in Foligno, he was suffering from a carcinoma of the kidney which involved the entire inferior vena cava up to its outlet in the right atrium of the heart, one of the four cardiac cavities. After a complex multidisciplinary evaluation carried out by urologists, cardiac surgeons, radiologists and anesthetists, the patient underwent renal embolization by the interventional radiologist 24 hours before the surgical procedure to minimize intra-operative bleeding.
It was a very complex surgical operation which, the Ao underlines in a note, required a new approach with very few cases described in the international scientific literature.
“In particular – explains the professor. Ettore Mearini, director of the Urology Clinic of the Perugia Hospital – the radical removal of the kidney and of all the tumor thrombus that reached the heart was carried out, opening the inferior vena cava”.
“To avoid bleeding– adds Dr. Marcello Bergonzini, director of Cardiac Surgery – the operation was performed by blocking cardiac activity, while maintaining the blood flow to the other organs through extra-corporeal blood circulation”.
“This surgical strategy – continues Mearini – allows for an improvement in 5-year survival of 31% of cases compared to those who are not operated on, although it must be underlined that, due to its complexity, it is burdened by an intra- and post-operative mortality rate. -operative 4-10% and an equally significant rate of complications, first and foremost, myocardial ischemia in 37% of cases and acute renal failure in 42.7% of cases. After approximately 6 hours, the minimally invasive surgery, which was perfectly successful, was concluded without excessive bleeding or other intra-operative complications.”
“Renal cell carcinoma represents approximately 3% of malignancies in adults – adds Mearini – One of the main characteristics of this tumor is the ability to invade the inferior vena cava, an event that occurs in 4-10% of cases. Invasion of the inferior vena cava, the largest vein in the human body, consists of the formation of tumor-like thrombi within it, leading to a reduction in the 5-year survival rate to approximately 60%. The treatment of caval thrombosis is routinely performed in the Urology Clinic, as it is also a reference center for this pathology, but in this case the action of the cardiac surgeon was fundamental for controlling cardiac activity”.
“The cardiac surgical approach that we developed during the operation – explains Bergonzini – concerns the mini-thoracotomy, a small intercostal incision which allowed us to avoid sectioning the sternum and opening the rib cage. This technique allowed the patient to face the post-operative phase more easily, having reduced the risks of bleeding, respiratory failure, infection of the surgical sites and prolonged immobilization to a minimum. All this allowed for a rapid convalescence without any significant complications.”
“From the analysis of international scientific literature, – comenta Mearini – the one performed at the Perugia Hospital is one of the very few cases of radical nephrectomy with stage IV caval thrombectomy in extracorporeal circulation obtained by means of a right anterior mini-thoracotomy. The choice to treat such a serious and complex pathology (renal carcinoma with thrombosis of the vena cava extending to the heart) was possible thanks to the presence in the hospital of highly specialized professionals who applied multidisciplinary treatments and used innovative surgical techniques. Investing in human and technological resources – concludes Mearini – is what is needed to keep the regional reference company at the levels it deserves”.
The patient, who is currently in excellent general condition at home, had a rapid and complete post-operative recovery.
08 May 2024
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