Publication Date
8-1-2023
Journal
Cureus
DOI
10.7759/cureus.44180
PMID
37641726
PMCID
PMC10460294
PubMedCentral® Posted Date
8-26-2023
PubMedCentral® Full Text Version
Post-print
Published Open-Access
no
Keywords
renal cell carcinoma (rcc), coronary artery disease, perioperative evaluation, cardiovascular and thoracic surgery, urologic surgery, multidisciplinary discussion
Abstract
A 49-year-old male with untreated type 2 diabetes and a family history of coronary artery disease (CAD) presented with right flank pain and profound progressive dyspnea on exertion to the emergency department of Ben Taub Hospital, a tertiary county hospital. Workup revealed right renal cell carcinoma with metastatic extension into the inferior vena cava (IVC). In addition, the patient had significant CAD with 95% occlusion of the proximal left anterior descending coronary artery amenable to percutaneous coronary intervention (PCI). After multidisciplinary discussions involving cardiovascular anesthesiology, cardiology, urology, and cardiothoracic surgery, it was estimated that the mortality benefit of immediate tumor resection outweighed the patient's need for PCI and further cardiac optimization. The patient underwent curative resection and thrombectomy under transesophageal echocardiography (TEE) guidance without complication, made an expedient recovery, and was discharged home on postoperative day seven.
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Anesthesiology Commons, Cardiology Commons, Endocrine System Diseases Commons, Endocrinology, Diabetes, and Metabolism Commons, Medical Sciences Commons, Nutritional and Metabolic Diseases Commons, Surgery Commons, Urology Commons