Team approach to rare cardiovascular, renal surgery at UT Southwestern provides impressive results

June 27, 2006

Dallas - June 27, 2006 - Steve Enfinger, 57, recently retired and enjoying a round of golf, had no reason to believe anything was seriously wrong one day in July 2001 when he was overcome with pain.

"I fell to the ground; I thought I had pulled a muscle," the Denton resident said.

It appeared to be no more than a simple strain until a few days later when Mr. Enfinger saw blood in his urine. After visiting several specialists, Mr. Enfinger was referred to Dr. Arthur Sagalowsky, professor of urology and surgery at UT Southwestern Medical Center. Dr. Sagalowsky diagnosed Mr. Enfinger with renal cell carcinoma.

Cancers of the kidney and renal pelvis are the 12th leading cause of cancer deaths in the United States. Mr. Enfinger had a rare complication, however. His tumor had a large clot growing out of the renal vein up the vena cava and into his heart.

Mr. Enfinger underwent a complex surgery at UT Southwestern Medical Center combining the skills of cardiovascular surgeons in the Heart, Lung and Vascular Clinical Center and renal surgeons in the Harold C. Simmons Comprehensive Cancer Center to remove his right kidney, affected lymph nodes and most of the massive tumor that had grown into the vena cava, the largest vein in the body. His case, along with 45 others, was examined for a review of patient outcomes in a study appearing in the June issue of the Journal of Thoracic and Cardiovascular Surgery.

Surgeons at UT Southwestern have taken a team approach involving urology, cardiothoracic surgery, interventional radiology and medical oncology to treat patients with this rare and complex type of kidney tumor and have recorded some of the most successful patient outcomes nationally.

"We now have experience as a group of doctors taking care of these high-risk surgical patients with terrific success rates compared with other clinics that perform similar surgeries," said Dr. Michael DiMaio, associate professor of cardiovascular and thoracic surgery. "Our five-year survival rate was among the highest of recent reviews of this type of surgery."

The one-year survival rate for patients is 78 percent, while two- and five-year survival rates are 69 percent and 56 percent, respectively. The surgery has been performed 46 times at UT Southwestern since the early 1990s.

"This achievement underscores an excellent approach to patient care in which two of our most distinguished surgeons have collaborated on a very complex procedure," said Dr. John McConnell, executive vice president for health system affairs. "We are pleased to be among the most innovative in the country and a top referral center for this kind of surgery."

Dr. DiMaio, senior author of the study, and Dr. Sagalowsky have worked together for more than seven years on patients with this type of cancer. The complex surgery involves removal of the cancerous kidney and removal of the tumor clot. The latter may require surgery inside the chest cavity with partial or even complete heart bypass. The combined kidney and cardiovascular procedure can last from 12 to 14 hours, and the surgeons must work simultaneously on the patient.

"We believe the team approach is the key to our good outcomes," Dr. Sagalowsky said.

In addition to the state-of-the art surgery, UT Southwestern patients also receive the latest drug therapies by medical oncologists to prevent recurrence or stop the growth of remaining tumor cells in cases where it was not feasible to remove the entire kidney tumor clot, Dr. Sagalowsky said.

Mr. Enfinger, for example, still has a small inoperable tumor mass below the vena cava, near the spot where the vein enters the liver. That tumor has been petrified by regular injections of the drug interferon.

"The treatment at UT Southwestern is awesome," Mr. Enfinger said. "I'm glad I had some of the best doctors in the country."
The UT Southwestern Harold C. Simmons Comprehensive Cancer Center combines the highest standards of individual care with innovative programs for cancer diagnosis, treatment and prevention based on UT Southwestern's internationally recognized research coupled with the most sophisticated equipment and advanced technologies available. The expertise of the physicians in the Simmons Cancer Center extends to virtually every cancer in every age group, from breast, urologic, gynecologic, lung, gastrointestinal, head and neck, brain, and skin to lymphomas, leukemia, and bone marrow transplantation.

The UT Southwestern Heart, Lung and Vascular Clinical Center is a collaborative effort between UT Southwestern faculty and community physicians who unite to bring their clinical and surgical expertise to patients needing cardiac, pulmonary or vascular care. Seamless, individualized care is available for adult congenital heart disease, cardiac imaging, cardiovascular and thoracic surgery, electrophysiology, general cardiology, heart failure, heart and lung transplant, interventional cardiology, interventional radiology, lung transplant pulmonology, mechanical circulatory assistance, preventive cardiology, pulmonary hypertension, and vascular and endovascular surgery.

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