Atrial Tumor Thrombus Research Articles

Stereotactic body radiation therapy as an effective local treatment for advanced hepatocellular carcinoma patients with inferior vena cava and right atrial tumor thrombus

BackgroundThe aim of our study was to evaluate the curative effect and safety of stereotactic body radiation therapy (SBRT) in treating hepatocellular carcinoma (HCC) patients with inferior vena cava (IVCTT) and right atrial tumor thrombus (RATT).MethodsThis retrospective study included fifteen advanced HCC patients with IVCTT and RATT who were treated with SBRT between 2013 and 2020. The prescribed dose delivered to the tumor was 45–50 Gy/7–10 fx. We report their treatment responses according to survival time and toxicities.ResultsFor these patients, the median follow-up time was 15 months (2–52 months). Local tumor control rates of the treated area were 80% at the time of death or at the last follow-up. The 6-month, 12-month, 18-month and 24-month OS rates were 80.0%, 60.0%, 33.3% and 26.7%, respectively. None of these patients died from the toxicity outcomes and complications of SBRT.ConclusionSBRT is an effective option for advanced HCC patients with IVCTT and RATT.

Multimodal imaging in hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus

Multimodal imaging in hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus

Concomitant Hepatectomy and Atrial Thrombectomy under Cardiopulmonary Bypass versus Staged Hepatectomy in the Treatment for Hepatocellular Carcinoma with Large Right Atrial Tumor Thrombi.

(1) Background: Hepatocellular carcinoma (HCC) with a large right atrium tumor thrombus (RATT) is a rare and critical presentation. Emergency hepatectomy and thrombectomy under cardiopulmonary bypass (CPB) is life-saving and potentially curative. The aim of this study is to propose an appropriate approach for this condition. (2) Methods: In period A (1998 to 2010, n = 7), hepatectomy and thrombectomy were concomitantly performed, and staged hepatectomy was performed in period B (2011 to 2018, n = 17). (3) Results: The median overall survival time (MOST) in the published studies was 14 months. Moreover, the blood loss, blood transfusion rate, length of ICU stays, and hospital costs were significantly reduced in period B. The MOSTs of patients in period A (n = 6) and period B (n = 17) were 14 vs. 18 months (p = 0.099). The median disease-free survival times (MDFTs) in period A (n = 6) and period B (n = 15) were 8 vs. 14 months (p = 0.073), while the MOSTs in period A and period B were 14 vs. 24 months (p = 0.040). (4) Conclusions: Emergency thrombectomy under CPB and staged hepatectomy 4–6 weeks later may be an appropriate approach for HCC with large RATT. However, the optimal waiting interval requires further investigation.

Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus

Tumor lysis syndrome (TLS) occurring after surgical resection of right atrium (RA) and inferior vena cava (IVC) tumor thrombus is a very rare but insidious condition. We report a case of hepatocellular carcinoma who developed TLS after uneventful excision of RA+IVC tumor thrombus under median sternotomy and cardiopulmonary bypass (CPB). Although the procedure was not expected to arouse massive tumor cell necrosis, post-operative course was complicated by metabolic acidosis, hypocalcemia, and progressive hyperkalemia indicative of TLS. Unfortunately, laboratory diagnosis of TLS was delayed under conditions of continuous renal replacement therapy (CRRT) for peri-operative acute renal failure. Despite all efforts, the patient died 36 hours after surgery due to lethal arrhythmia and disseminated infarction of the kidneys, spleen, and liver.

Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus

Introduction:We aimed to present our experience in managing renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus.Methods:Records of all patients aged 18 years and older, with a diagnosis of primary renal masses with IVC thrombus, presenting to our institute from January 2012 to August 2020 were retrospectively reviewed. Patients with tumor thrombus limited only to renal vein were excluded from the analysis. Their hospital course and outcomes were recorded and evaluated for predictors of survival.Results:During the study period, we treated 61 patients with a renal mass and concurrent IVC thrombus and 56 of these underwent surgery. 7 of them had level III and 6 had level IV thrombus. A total of six patients received neoadjuvant tyrosine kinase inhibitor (TKI) therapy and all of them showed a decrease in size and level of tumor thrombus and cardiopulmonary bypass was safely avoided. Fourteen patients had distant metastasis and underwent cytoreductive surgery and of these 12 patients received TKI therapy after surgery with a mean survival of 26.8 months. The overall survival at 2 and 5 years of nonmetastatic group was 81.1% and 47.5% respectively and in metastatic group was 35.1% and 0%, respectively. Poor performance status, distant metastasis, higher T stage, higher thrombus levels, and positive surgical margins were all predictors of decreased survival.Conclusions:Complete surgical resection in both nonmetastatic and metastatic RCC with IVC thrombus has long-term survival benefits. Neoadjuvant TKI therapy, with adequate preoperative planning, helps in decreasing the size of the thrombus and in safely avoiding bypass in level III and IV IVC thrombi.

Surgery for renal cell carcinoma extending to the right atrium in Japanese institutions: Focusing on cardiopulmonary bypass with or without deep hypothermic circulatory arrest.

To evaluate the outcomes of Japanese patients with renal cell carcinoma undergoing surgery for tumor thrombus invading the right atrium. We retrospectively evaluated 23 patients who underwent extracorporeal circulation-assisted surgery at two institutions. Perioperative outcomes and survival rates were evaluated and compared between two groups of patients, which were set according to the use or not of deep hypothermic circulatory arrest. Data on systemic treatments were assessed. The median age was 64years; the majority of patients were fit according to the Charlson Comorbidity Index. Five (21.7%) patients had at least one distant metastasis, and 17 (73.9%) received systemic therapy. A total of 16 (69.6%) patients underwent deep hypothermic circulatory arrest. Baseline characteristics were comparable between groups. Patients who underwent deep hypothermic circulatory arrest had a non-significant reduction in blood loss compared with those who did not undergo this procedure (1866.0 vs 3513.0mL, P=0.102). The complication rate, both of any grade (43.8% vs 71.4%, P=0.215) and grade ≥3 (6.3% vs 28.6%, P=0.162), tended to be lower in patients who underwent deep hypothermic circulatory arrest. The mean 90-day mortality rate was 8.7%, with no difference among groups (6.3% vs 14.3%, respectively; P=0.545). The overall median cancer-specific and overall survival were both 64.4months, and did not differ between groups. Renal cell carcinoma patients undergoing extracorporeal circulation-assisted surgery and systemic therapy for right atrial tumor thrombus have acceptable long-term survival rates. Outcomes are comparable regardless of the use of deep hypothermic circulatory arrest.

Hepatocellular carcinoma with right atrial tumor thrombus.

Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis. By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t, Fisher exact and I2 tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care. The overall survival rate of this cohort was 40.8 %. The survival rate of patients receiving TACE was 33.3 % and that of surgical patients was 41.9 %. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7 ± 16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major morbidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care > radiotherapy > surgery > TACE > interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports. Advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy. Based on the results of median survival time, radiotherapy and TACE seemed to be associated with an improved prognosis and possible better survival.

Preoperative transcatheter arterial chemoembolization (TACE) and systemic chemotherapy for treatment of wilms’ tumor with atrial tumor thrombus: One case report

Preoperative transcatheter arterial chemoembolization (TACE) and systemic chemotherapy for treatment of wilms’ tumor with atrial tumor thrombus: One case report

Removal of the Tumor Thrombus from the Right Atrium without Extracorporeal Circulation: Emphasis on the Displacement of the Tumor Apex.

Objectives To assess the outcomes of cavoatrial tumor thrombus removal using the liver transplantation technique for thrombectomy, a retrospective study was conducted. Materials and Methods Five patients with atrial tumor thrombi who underwent piggy-back mobilization of the liver, surgical access to the right atrium from the abdominal cavity, and external manual repositioning of the thrombus apex below the diaphragm (milking maneuver) were included into the study. Extracorporeal circulation was used in none of the cases. The average length of the atrial component of the tumor was 20.0 ± 11.7 mm (10 to 35 mm), and the width was 14.8 ± 8.5 mm (10 to 30 mm). In this work, the features of patients and surgical interventions as well as perioperative complications and mortality were analyzed. Results External manual repositioning of the tumor thrombus apex below the diaphragm was successfully performed in all patients. Tumor thrombi with the length of the atrial part up to 1.5 cm were removed through the extrapericardial approach. For evacuation of the thrombi with the large atrial part (3.0 cm or more), a transpericardial surgical approach was required. Specific complications associated with the access to the right atrium from the abdominal cavity (paresis of the right phrenic nerve, pneumothorax, and mediastinitis) were not detected in any case. The average clamping time of the supradiaphragmatic inferior vena cava (IVC) was 6.3 ± 4.6 min. The volume of intraoperative blood loss varied from 2500 to 5600 ml (an average of 3675 ± 1398.5 ml). Conclusion Our work represents the initial experience in the liver transplantation technique for thrombectomy in distinct and well-selected patients with atrial tumor thrombi. The effectiveness of this approach needs further study. The video presentation of our research took place in March 2019 at the 34th Annual EAU Congress in Barcelona.

Palliative External Beam Radiation Therapy for Hepatocellular Carcinoma With Right Atrial Tumor Thrombus

Hepatocellular carcinoma (HCC) with right atrial (RA) tumor thrombus via progression through hepatic veins into the inferior vena cava is a challenging entity with limited treatment options. We describe a case of a patient with a symptomatic HCC RA tumor thrombus who achieved a durable and effective symptomatic response to palliative radiotherapy. We also report our institution's experience treating 10 HCC patients with RA tumor thrombus with palliative radiotherapy to a median biological effective dose (α/β = 10) of 50.6 Gy (range, 29.3-71.2 Gy). Median follow-up was 5 months. Palliative radiotherapy was well-tolerated, with no grade ≥ 3 acute toxicities. Only one patient experienced in-field progression. Seven patients were alive at least 3 months following radiotherapy, and median overall survival was 5 months (range, 3-15 months). This unique series suggests HCC RA tumor thrombus-directed radiotherapy may offer safe palliation and can be considered to improve patients' quality of life.

2453 Inferior Vena Cava Syndrome in Hepatocellular Carcinoma With Tumor Extension Into the Right Atrium

INTRODUCTION: Cardiac involvement in hepatocellular carcinoma is rare. This includes intra-atrial metastases, and tumor thrombus with extension of tumor into the inferior vena cava and the right atrium. We describe a patient presenting with inferior vena cava syndrome complicating hepatocellular carcinoma with extension of tumor into the inferior vena cava and the right atrium. CASE DESCRIPTION/METHODS: An 83 year old female with a history of hepatocellular carcinoma and underlying cirrhosis presented with bilateral leg edema to her thighs, and abdominal distension. She had a history of hepatitis C successfully treated with direct acting anti-viral therapy. Her hepatocellular carcinoma was treated with radiofrequency ablation. Several months later, she received transarterial chemo-embolization for recurrent hepatocellular carcinoma. She remained well for one year and was lost to follow-up, until she presented with bilateral leg edema, abdominal distension and shortness of breath. Physical exam showed no jugular venous distension. She had moderate abdominal distension with shifting dullness, hepatomegaly, and edema to both lower extremities extending to her thighs. Computed tomography of her abdomen with and without contrast revealed hepatomegaly with a large tumor mass in the left lobe of the liver extending into the inferior vena cava and right atrium. The thrombus in the inferior vena cava and right atrium showed contrast enhancement. Ascites was present. 2D echo showed tumor thrombus in her right atrium. The patient was diagnosed with inferior vena cava syndrome due to extension of hepatocellular carcinoma into her inferior vena cava and right atrium. She had some improvement with diuretics, and was discharged home to hospice care. DISCUSSION: Hepatocellular carcinoma with tumor extension into the inferior vena cava and atrium is rare. This can present with inferior vena cava syndrome, superior vena cava syndrome, or both. Aggressive treatments have been performed in this situation, including surgical resection of the atrial tumor thrombus while under cardio-pulmonary bypass, with or without resection or ablation of the hepatocellular carcinoma. Given the understandably poor prognosis and age of the patient, hospice care was chosen. Tumor extension into the inferior vena cava and right atrium should be considered in patients with advanced hepatocellular carcinoma presenting with inferior vena cava syndrome.

Transcatheter arterial chemoembolization experience for advanced hepatocellular carcinoma with right atrial tumor thrombus.

Hepatocellular carcinoma (HCC) with tumor thrombus extending to the inferior vena cava (IVC) and right atrium (RA) is rare, which is generally associated with serial syndromes and poor prognosis. The results of earlier observations revealed that the median survival was 1-5 months after diagnosis for untreated patients. The prognosis was poor with surgery, radiotherapy, transarterial chemoembolization (TACE), and chemotherapy. A total of 1850 patients received TACE for advanced HCC at our institution from October 2011 to September 2016. Among them, 18 cases presented tumor thrombus extended from hepatic vein to IVC and RA. TACE was performed to deal with the tumor thrombus inside the RA, and angiography was performed for characterizing. The successful rate, survival, safety, and clinical adverse events were retrospectively studied. A total of 56 interventional procedures were conducted for the 18 cases of tumor thrombus extending to IVC and RA. TACE were successfully performed in all patients without significant complications. One case died of pneumonia, and no severe adverse effect was observed in the other 17 cases. The 1- and 3-year overall survival rates were 50% and 16.7%, respectively. The average survival from diagnosis of right atrial tumor thrombus (RATT) was 15.2 months. The blood supply was rich for all RATT. There were seven cases with single-feeding artery and 11 cases with two or three feeding arteries that originated from intra- or extra-hepatic arteries. The extrahepatic artery played a critical role in the blood supply of RATT, including right inferior phrenic artery (8/18), left inferior phrenic artery (1/18), and the left gastric artery (2/18). For HCC with tumor thrombus in the IVC and RA, TACE could safely improve the prognosis of these patients. Searching for multiple feeding arteries are essential for ensuring efficacy. In addition, careful examination and appropriate embolization technique are essential for safety and efficacy. Lipiodol was a safe and ideal agent for the embolization in RATT.

Surgical Procedures and Perioperative Management for Non-small Cell Lung Cancer Complicated with Left Atrial Tumor Thrombus

背景与目的非小细胞肺癌合并左房瘤栓病例在局部晚期肺癌中占有一定比例，积极外科手术能否带来获益，以及具体术式选择均存在争议，是目前外科研究的热点。我们报告了单中心接受手术治疗的非小细胞肺癌合并左房瘤栓病例队列，结合预后分析探究合理的诊疗方法。方法自2006年8月-2017年7月共有11例非小细胞肺癌合并左房瘤栓病例在中日友好医院胸外科确诊并行手术治疗，对其临床资料、治疗选择、病理类型、预后情况进行了回顾性研究。结果11例患者中，男性7例，女性4例，平均年龄57.9岁，6例患者接受术前新辅助放化疗。全部患者手术过程顺利，其中行正中开胸体外循环下手术3例，体外膜肺氧合辅助下后外侧切口入路手术1例，常规后外侧切口入路手术6例，胸腔镜辅助小切口入路手术1例。手术达R0切除9例，R1切除2例。手术用时210 min-380 min，平均292 min，出血量100 mL-1, 600 mL，平均436 mL。全组有1例（9.1%）术后90天内死亡病例，另有4例（36.4%）出现心律失常、脑梗、低氧血症等围术期并发症。术后病理诊断鳞癌6例，腺癌4例，肉瘤样癌1例，病理分期pT4N0M0 7例，pT4N1M0 4例。术后对9例患者行辅助化疗，随访期内对2例患者行放射治疗。全组随访时间2个月-53个月，3年无病生存率30.7%，中位无病生存期31个月，3年总体生存率49.1%，中位总体生存期为33个月。结论对有选择的非小细胞肺癌合并左房瘤栓患者，选择合理术式切除肿瘤病灶和肺静脉、左房内瘤栓，加强围术期管理并配合新辅助/辅助化放疗，可能获得满意的预后。

Diagnosis and treatment of renal cell carcinoma complicated with inferior vena cava tumor thrombus in hepatic segment and upper hepatic segment

Surgical treatment is the only cure treatment for patients with inferior vena cava tumor thrombus in hepatic segment and upper hepatic segment. The accurate diagnosis of tumor thrombus is very important. In preoperative imaging examination, the abdominal enhanced CT scan and the inferior vena cava MRI scan were the best methods for the diagnosis and evaluation of the tumor thrombus in hepatic segment and upper hepatic segment. Compared with the tumor thrombus below the liver, the tumor thrombus in hepatic segment or above hepatic segment extend widely, and the operation are more difficult. For simple inferior vena cava tumor thrombus (the top of the thrombus has reached the level of hepatic vein), Retroperitoneal approach combined with transperitoneal approach should be used. Open surgery is the standard procedure for other tumor thrombus in hepatic segment and upper hepatic segment. In addition to exposure of inferior vena cava below the hepatic vein, the liver and the first hepatic hilum should be exposed. For tumor thrombus in the atrium, after the longitudinal incision of diaphragm, we use Milking technology to squeeze thrombus into inferior vena cava. Then we use catheterization technology to remove thrombus. For difficult atrial tumor thrombus, an extracorporeal circulation should be performed. The median incision in the chest should be performed to open the chest and open the pericardium and remove the tumor thrombus. Patients with tumor thrombus in hepatic segment or upper hepatic segment should be diagnosed as early as possible and they need actively treated by operation. Key words: Renal carcinoma; Tumor thrombus; Inferior vena cava; Hepatic segment

Hepatocellular carcinoma with inferior vena caval and right atrial tumor thrombi and massive pulmonary artery embolism: A case report.

The aim of the present study was to report the case of a 55-year-old female patient with a sizeable (7.1×6.2 cm) hepatocellular carcinoma (HCC), who succumbed to massive pulmonary artery embolism. The main symptoms included sudden thoracodynia, dyspnea and transient coma. The initial diagnosis was HCC according to the typical abdominal ultrasound and triple-phase abdominal computed tomography (CT) findings, chronic hepatitis B infection and elevated α-fetoprotein levels (1,036 µg/l; normal, 0-20 µg/l). Two days following admission, the patient developed recurrent chest pain and shortness of breath. The electrocardiogram and myocardial enzyme levels were normal, but the D-dimer level was elevated to 7,210 µg/l (normal, 0-550 µg/l). Magnetic resonance angiography and a contrast-enhanced chest CT confirmed that the inferior vena cava and right atrium were invaded by tumor thrombi; the bilateral pulmonary embolism was also suspected to be formed by tumor thrombi. The final diagnosis was HCC with inferior vena caval and right atrial tumor thrombi, as well as massive pulmonary embolism. Anticoagulation therapy with low-molecular weight heparin calcium was administered; however, the patient succumbed to pulmonary embolism in <2 months.

Surgical resection of recurrent extrahepatic hepatocellular carcinoma with tumor thrombus extending into the right atrium under cardiopulmonary bypass: a case report and review of the literature.

BackgroundRecurrent hepatocellular carcinoma accompanied by a right atrial tumor thrombus is rare. No standard treatment modality has been established. Surgical treatment may be the only curative treatment; however, surgery has been considered high risk. We herein describe a patient who underwent resection of a recurrent right atrial tumor thrombus under normothermic cardiopulmonary bypass on a beating heart.Case presentationA 60-year-old man underwent a right hepatectomy for hepatocellular carcinoma with diaphragm invasion. During the preoperative cardiac screening, he was diagnosed with an old myocardial infarction with triple-vessel coronary disease. Percutaneous coronary intervention was performed for the left anterior descending artery and left circumflex coronary artery. High-grade stenosis remained in his right coronary artery. Nine months later, computed tomography showed recurrent hepatocellular carcinoma in the diaphragm and a tumor thrombus extending from the suprahepatic inferior vena cava into the right atrium. Surgical resection of the recurrent tumor was performed through a right subcostal incision with xiphoid extension and median sternotomy. The recurrent tumor was incised with the diaphragm and pericardium. Intraoperative ultrasonography revealed that the tumor thrombus was free from right atrium wall invasion and that the right atrium could be clamped just proximal to the tumor thrombus. The right atrium, infrahepatic vena cava, left and middle hepatic veins, and hepatoduodenal ligament were encircled. Cardiopulmonary bypass was performed to prevent ischemic heart disease caused by intraoperative hypotension. Total hepatic vascular exclusion was then performed under normothermic cardiopulmonary bypass on heart beating. The inferior vena cava wall was incised. The tumor thrombus with the diaphragmatic recurrent tumor was resected en bloc. The patient had a favorable clinical course without any complications.ConclusionThe recurrent hepatocellular carcinoma in the diaphragm and the right atrial tumor thrombus were safely resected using normothermic cardiopulmonary bypass on heart beating.

Stereotactic radiotherapy for the treatment of lung cancer with a giant left atrial tumor thrombus: A case report and literature review.

Lung cancer presenting with a giant atrial tumor thrombus is particularly rare. Surgical resection, aided by a cardiopulmonary bypass, is the standard treatment of choice if there is no distant metastasis. However, this form of surgery carries a high risk, with the subsequent patient prognosis being extremely poor. The current study describes the case of a 52-year-old man presenting with left lung squamous cell carcinoma that had extended into the left atrium. The patient was treated with stereotactic radiotherapy, and regarding the atrial disease, a complete response was achieved within 12 months. The present case demonstrates that stereotactic radiotherapy may be a beneficial palliative treatment for patients with stage IV lung cancer invading the left atrium.

A rare case of hepatocellular carcinoma with right atrial invasion

An elderly male came with h/o loss of appetite and weight loss since 3 months. On evaluation, prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR) values were high. Hepatitis B surface antigen (HbSAg) screening was reactive and serum alfa-fetoprotein (AFP) was raised. Ultrasound examination revealed a hepatic mass with inferior vena caval extension and direct invasion of the right atrium. Computed tomography (CT) scan of the lower thorax and abdomen was performed, which confirmed the ultrasound diagnosis. The patient had a brief stay in the hospital and got discharged against medical advice; he was not available for follow-up. Hepatocellular carcinomas (HCCs) commonly metastasizes to the lung, bone, brain, and adrenal glands. About 70% of the patients with HCCs have hepatic and portal vein invasions but encroachment into the right atrium is very rare. The most common symptoms of cardiac metastasis include asymptomatic cases, bilateral lower leg edema, and exertional dyspnea in that order. Typical complications of intravascular tumor extension lead to secondary Budd-Chiari syndrome, right heart insufficiency, or massive pulmonary embolism. The prognosis of HCC with atrial invasion is poor, with median survival ranging from 1 month to 4 months. HCC in these cases may be more aggressive, with a shorter doubling time. The risk for cardiopulmonary collapse is higher, with heart failure or sudden death. Surgical interventions as well as nonsurgical approaches have been used in the treatment of patients with symptomatic inferior vena cava (IVC)/right atrial tumor thrombi. There are few reports of en bloc hepatectomy and resection of the right atrial thrombus under cardiopulmonary bypass. Routine screening in patients with HCC, such as including chest imaging as part of surveillance computed tomographic scans, may facilitate earlier detection and treatment.

Surgical treatment of renal carcinoma with atrial tumor thrombus avoiding cardiopulmonary bypass: step-by-step description.

Tumor thrombus in the inferior vena cava (IVC) occurs in 4-10% of patients with renal cell carcinoma (RCC) and poses a challenge for the surgical team. Because there is no systemic therapy available to significantly reduce tumor burden, surgical intervention is the only treatment. However, the surgical approach is associated with significant morbidity and mortality. When the thrombus extends above the diaphragm, the use of cardiopulmonary bypass (CPB) and accompanying deep hypothermic circulatory arrest (DHCA) has usually been advocated. However, complications inherent to CPB and DHCA, such as coagulopathy and central nervous system complications, have led us to search for an alternative surgical approach to these tumors. The purpose of this study is to describe the surgical technique used in five patients with large RCC with tumor thrombus extending into the supradiaphragmatic IVC and Right atrium (RA), Right atrium, who underwent extensive resection without CPB and DHCA.

Video-assisted thoracoscopic surgery in the treatment of non-small-cell lung cancer complicated with left atrial tumor thrombus.

We report a case of pulmonary squamous cell carcinoma complicated with a tumor thrombus in the left atrium. The left atrial tumor thrombus, together with the left lower lobe, was removed via complete video-assisted thoracoscopic surgery (VATS), with cardiopulmonary bypass standby. The patient recovered well from surgery, received four cycles of postoperative chemotherapy, and is now under follow-up at the outpatient clinic. Although the optimal treatment is still controversial, simultaneous VATS and atriotomy under the premise of preoperative evaluation of the thrombus, including size and extent, might prevent systemic embolization and sudden death, alleviate the wound, promote postoperative rehabilitation, and improve prognosis in selected patients.