Multidisciplinary approach in treatment of a patient with locally advanced renal cancer and critical coronary artery disease: clinical case

Today, the tactics of treating tumor diseases of the urinary tract with concomitant pathology of the cardiovascular system are the subject of active discussion in the scientific community. There is a small number of published clinical cases, and only small retrospective monocentric series. The goal of this clinical case presentation is to help to establish the correct sequence of treatment steps and determine the priority of each medical intervention in this difficult cohort of patients. The article presents the result of successful radical nephrectomy in a patient with papillary renal cell carcinoma pT3aN0M0 one month after coronary artery bypass grafting for multivessel coronary artery disease.

1. Zielinski J., Jaworski R., Pawlaczyk R. et al. Simultaneous surgery for critical aortic stenosis and gastric cancer: a case report. World J Gastroenterol 2010;16(9):1161–4. DOI: 10.3748/wjg.v16.i9.1161

2. Takahashi T., Nakano S., Shimazaki Y. et al. Concomitant coronary bypass grafting and curative surgery for cancer. Surg Today 1995;25:131–5. DOI: 10.1007/BF00311084

3. Watanabe S., Shimokawa S., Sakasegawa K. et al. Simultaneous operation for lung tumor and cardiovascular disease. Kyobu Geka 2000;53:353–7.

4. Moertel C.G. Multiple primary malignant neoplasms: historical perspectives. Cancer 1977;40:1786–92. DOI: 10.1002/1097-0142(197710)40:4+<1786::aid-cncr2820400803>3.0.co;2-2

5. Chissov V.I., Trakhtenberg A.K. Multiple primary malignant tumors. Moscow: Meditsina, 2000.

6. Kharchenko V.P., Kusmin I.V. Lung cancer. Moscow: Meditsina, 1994.

7. Darwazah A.K., Shehata S. Detrimental effect of cardiopulmonary bypass (CPB) on malignant disease. J Cardiothorac Surg 2011;6:13. DOI: 10.1186/1749-8090-6-13

8. Litmathe J., Atmaca N., Menghesha D., Krian A. Combined procedures using the extracorporeal circulation and urologic tumor operation – experiences in six cases. Interact Cardiovasc Thorac Surg 2004;3:132–5. DOI: 10.1016/s1569-9293(03)00236-6

9. Davydov M.I., Akchurin R.S., Gerasimov S.S. et al. Simultaneous operations in thoraco-abdominal clinical oncology. Eur J Cardiothorac Surg 2001;20:1020–4. DOI: 10.1016/s0169-5002(00)80468-7

10. Hill G.E., Whitten C.W., Landers D.F. The influence of cardiopulmonary bypass on cytokines and cell-cell communication. J Cardiothorac Vasc Anesth 1997;11:367–75. DOI: 10.1016/s1053-0770(97)90107-5

11. Peeters B., Moreels N., Vermassen F., van Herzeele I. Management of abdominal aortic aneurysm and concomitant malignant disease. J Cardiovasc Surg (Torino) 2019; 60(4):468–75. DOI: 10.23736/s0021-9509.19.1094

12. Davydov M.I., Akchurin R.S., Gerasimov S.S. et al. Simultaneous surgery of competing cardio-vascular and malignant diseases of lungs and mediastinum. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2010;(8):4–10. (In Russ.).

13. Khatkov I.E. Presentation at the general meeting of the Medical Sciences Division of the Russian Academy of Sciences from 27.05.2024. (In Russ.).

14. Lishchuk A.N., Kokhan E.P., Iliukhin M.A. et al. The simultaneous aortocoronary by-pass and nephrectomy for the renal cancer. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2013;(7):52–4. (In Russ.).

15. Ostrovsky Yu.P., Sukonko O.G., Zharkov V.V. et al. Simultaneous surgical treatment of patients with renal cell carcinoma concomitant with heart disease. Onkourologiya = Cancer Urology 2006;2(1):10–2. (In Russ.). DOI: 10.17650/1726-9776-2006-2-1-10-12

16. Dedeilias P., Roussakis A., Koletsis E.N. et al. Simultaneous offpump coronary artery bypass graft and nephrectomy. J Card Surg 2008;23(6):750–3. DOI: 10.1111/j.1540-8191.2008.00663.x

17. Fujiwara K., Naito Y., Komai H. et al. Combined coronary artery bypass with right nephrectomy in a patient with left main lesion, calcified ascending aorta, pelvic carcinoma and liver cirrosis. Kyobu Geka 1998;51(7):570–4.

18. Davydov M.I., Akchurin R.S., Gerasimov S.S. et al. Surgical treatment of patients with kidney and bladder cancer in case of severe concomitant cardiovascular diseases. Khirurgiya. Zhurnal im. N.I. Pirogova = Pirogov Russian Journal of Surgery 2014;(9):4–16. (In Russ.).

19. Darwazah A.K. Surgical management of coronary artery disease associated with malignancy. J Card Surg 2012;27:581–8. DOI: 10.1111/j.1540-8191.2012.01514.x

20. Cetin E., Ozyuksel A., Akay F. Staged off-pump coronary artery bypass grafting and radical nephrectomy in a patient with multivessel coronary artery disease and a renal tumour. BMJ Case Rep 2014;2014:bcr2013202481. DOI: 10.1136/bcr-2013-202481