Surgical approach to renal tumors with cardiovascular extension in children

Objectives: Pediatric renal tumors with intravascular extension require complex surgery. The extent of venous and intracardiac involvement determines the operative strategy. We report 3 children with unilateral renal tumors and intravascular extension who underwent complete tumor resection using tailored surgical approaches. Methods: We retrospectively reviewed 3 pediatric cases of renal tumors with intravascular extension. Accompanying surgical videos demonstrate the operative techniques. Results: All patients had primary renal tumors extending into the ipsilateral renal vein and inferior vena cava, with variable extension into the right atrium. Two children had Wilms tumor with partial response to neoadjuvant chemotherapy. The third had clear cell sarcoma of the kidney that did not respond to therapy and required urgent surgery for progressive heart failure and risk of tricuspid valve obstruction. Surgical strategies were individualized according to the level of vascular involvement. Complete resection with negative margins and inferior vena cava preservation was achieved in all patients. All children were successfully extubated within 2 to 5 days and discharged within 2 weeks postsurgery. Conclusions: Complete en bloc resection of pediatric renal tumors with intravascular extension is feasible and safe with meticulous planning and appropriate use of cardiopulmonary bypass. Preservation of venous return and contralateral renal function is essential. The accompanying videos illustrate key technical steps to achieve safe and effective resection.