le="line-height:150%">Long-term survival after surgical treatment is possible in patients with renal cell carcinoma (RCC) extending in the right atrium. Different surgical techniques for the treatment of patients with RCC extending into the vena cava have been advocated, depending on the proximal extent of the tumor. We present and propose an algorithm regarding the operative strategy depending on the extent of tumor growth.

le="line-height:150%">From 1984 to 1996, four patients with transvenous intracardiac tumor extension underwent operations in the Kobe University Hospital. The primary tumors of two were intravenous leiomyomatoses originating from the uterus; a third patient had invasive thymoma, and the fourth patient had clear cell sarcoma of the kidney. In 1985, one patient had a curative, staged resection. One-stage operations were carried out in three patients, and all intracardiac tumors were successfully resected en bloc with the primary tumors under conditions of electrical ventricular fibrillation and mild hypothermia. Combined venous reconstructions were necessary for en bloc resection in three cases. Two patients with malignancy received postoperative chemoradiotherapy, and all four patients were discharged uneventfully from our hospital. We consider radical resection with curative intent only for patients with tumors extending into the heart. In these cases, a one-stage operation is preferable, and electrical ventricular fibrillation with mild hypothermia is a recommended method of circulatory assist because of its simplicity. (J Vasc Surg 1998;27:740-4.)