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Background <p>Primary renal sarcomas in adults are rare, accounting for 1% of all renal tumors. They progress rapidly and are resistant to radiotherapy and chemotherapy. Currently, surgery is the only effective treatment.</p> Case presentation <p>A 49-year-old man was admitted with a left kidney mass and inferior vena cava (IVC) tumor thrombus extending into the right atrium (Mayo grade IV). He underwent laparoscopic radical nephrectomy and tumor thrombus removal under extracorporeal circulation with moderate hypothermic circulatory arrest (25&#xa0;°C) and bilateral selective antegrade cerebral perfusion. This technique ensured minimal bleeding while providing effective protection for the brain and coagulation system. The total circulatory arrest time was 91&#xa0;min, with stable cerebral oxygen saturation throughout.</p> Conclusions <p>Moderate hypothermic circulatory arrest combined with bilateral antegrade cerebral perfusion, along with a multidisciplinary perioperative management strategy, ensured a favorable prognosis for this patient with a Mayo level IV tumor thrombus. This report aims to provide a reference for the perioperative management of patients with Mayo grade IV tumor thrombi.</p>

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Anesthetic management of primary renal sarcoma with Mayo IV tumor thrombus using moderate hypothermic circulatory arrest and antegrade cerebral perfusion: a case report

  • 期刊论文

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  • 发表日期：

    2026年4月29日

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  • Zhaoyu Huang,
  • Suli Chen,
  • Guohua Zhang,
  • Liangyuan Lu,
  • Yanjun Lin

摘要

Background

Primary renal sarcomas in adults are rare, accounting for 1% of all renal tumors. They progress rapidly and are resistant to radiotherapy and chemotherapy. Currently, surgery is the only effective treatment.

Case presentation

A 49-year-old man was admitted with a left kidney mass and inferior vena cava (IVC) tumor thrombus extending into the right atrium (Mayo grade IV). He underwent laparoscopic radical nephrectomy and tumor thrombus removal under extracorporeal circulation with moderate hypothermic circulatory arrest (25 °C) and bilateral selective antegrade cerebral perfusion. This technique ensured minimal bleeding while providing effective protection for the brain and coagulation system. The total circulatory arrest time was 91 min, with stable cerebral oxygen saturation throughout.

Conclusions

Moderate hypothermic circulatory arrest combined with bilateral antegrade cerebral perfusion, along with a multidisciplinary perioperative management strategy, ensured a favorable prognosis for this patient with a Mayo level IV tumor thrombus. This report aims to provide a reference for the perioperative management of patients with Mayo grade IV tumor thrombi.