A response to the letter from González et al. For renal cell carcinoma with intra-atrial tumour thrombus, they advocate their effort to avoid cardiopulmonary bypass and deep hypothermic circulatory arrest wherever possible and, to compensate for the safe bloodless field, their use of the refined technique of advanced liver dissection used in liver transplantation.
In reaction, the authors give a balanced view of the benefits and potential drawbacks of the use of cardiopulmonary bypass and deep hypothermic circulatory arrest for surgical management of the renal cell carcinoma and intracardiac tumor thrombus which they prefer from view of surgical safety and precision of tumor extirpation.