Effective use of extracorporeal membrane oxygenation in surgical treatment of kidney cancer patient with tumor thrombosis

The presented clinical case demonstrates the potential of medical technologies with organ replacement in the treatment for kidney cancer (KC) with a tumor thrombus located in the retrohepatic inferior vena cava (IVC) complicated by thromboembolism of the medium and small branches of the pulmonary artery (PATE). The treatment outcomes in such patients are usually poor due to a great number of complications and high mortality. The literature data estimates operative mortality rate of 13 %, and the frequency of early postoperative complications reaches 60 %. Standard approaches to anesthesia in case of thromboembolism and the threat of massive PATE are ineffective. In this clinical case, we chose the therapeutic tactics with extracorporeal membrane oxygenation (ECMO) in the intra- and early postoperative period in order to avoid or minimize life-threatening complications in the KC patient with a tumor thrombus in IVC and PATE. The effective use of ECMO minimized the risk of fatal complications during nephrectomy with thrombectomy for a malignant kidney tumor in the patient with pulmonary embolism and subcompensated disorders of the oxygen transport function of the lungs. The main objective of medical care for this patient involved both the radical treatment of kidney cancer and the elimination of a potential cause of thromboembolism of the pulmonary artery branches, fragments of hematogenous and tumor microthrombi. The total duration of ECMO was 30 hours. No significant complications in organs and systems were recorded during the surgery and in the early postoperative period. The development and implementation of new technologies, including devices for oxygen blood saturation and carbon dioxide elimination, undoubtedly gives a chance for a cure for cancer patients with decompensated organ and functional capabilities.

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