84-year-old lady with localised small central renal tumour
- Congestive cardiac failure
- Recent hospital admissions with dyspnoea and significant decompemsation
- NYHA class 4. Housebound, walks 20m on flat
- Echo 2020: Mild pulmonary hypertension and mod-severe AR
- Recent echo – significant deterioration. Severe pulmonary hypertension; PASP = 66mmHg, dilated RV, Moderate MR, Moderate-Severe AR, Mod TR
- Respiratory component?
- No formally diagnosed lung disease
- Respiratory physician and spirometry organised and pending
- Renal cell carcinoma
- Very small cancer: 3cm, central so not appropriate for ablation currently.
- Issues are local growth and bleeding.
- Tumour progression and Metastatic disease usually occur very slowly.
- There may be less invasive procedures available to address local symptoms/tumour may become amenable to ablation as it increases in size
- Significant risk of perioperative M&M
- Patient states quality of life more important than quantity, happy to continue the way she is for the next year or longer
- High risk of death from current cardiac disease and pulmonary hypertension
- RCRI 2-3
- Surgeon has organised meeting with patient and family to discuss options for non-surgical management
- To continue with respiratory review – options for symptomatic improvement and optimisation for further, less invasive procedures