Extension of Renal Cell Carcinoma into the Vena Cava: Clinical Review and Surgical Approach
- 1 March 1986
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Urology
- Vol. 135 (3), 460-464
- https://doi.org/10.1016/s0022-5347(17)45691-6
Abstract
Between 1972 and 1983, 25 patients were treated for renal carcinoma with tumor extension into the vena cava but without other clinical evidence of disseminated disease. Of these patients 12 had vena caval tumor thrombus extension up to the level of the hepatic veins (group 1), 10 had extension into the intrahepatic vena cava (group 2) and 3 had tumor extending into the right atrium (group 3). A perioperative management plan and an anatomical surgical approach have been developed to allow safe en bloc removal of these extensive tumor thrombi without removal of the vena cava. Successful management is dependent upon preoperative evaluation to determine precisely the extent of the disease, prophylaxis against pulmonary embolism and a well planned surgical method. For patients without evidence of metastatic or perinephric disease, the 5-year actuarial survival rate of 33 per cent is comparable to that of other patients without thrombus. Complete resection was possible in 20 patients (80 per cent), with a 5-year actuarial survival rate of 36 per cent. While patients with metastatic tumor cannot be cured, short-term palliation can be achieved for patients who have an imminent risk of vena caval occlusion or pulmonary embolism by an en bloc removal of tumor and thrombus, even for those with intra-atrial extension. Over-all, operative intervention was successful, with 22 of 25 patients leaving the hospital alive.Keywords
This publication has 20 references indexed in Scilit:
- Renal Cell CarcinomaJournal of Urology, 1982
- Inferior Venacavography in the Preoperative Assessment of renal AdenocarcinomaJournal of Urology, 1982
- The Influence of Perinephric Fat Involvement on Survival in Patients with Renal Cell Carcinoma Extending into the Inferior Vena CavaJournal of Urology, 1982
- Surgical Approach to Intracardiac Renal Cell CarcinomaThe Annals of Thoracic Surgery, 1982
- Massive Intraoperative Pulmonary Tumor Embolus from Renal Cell CarcinomaAnesthesiology, 1981
- Surgical Approach for Removal of Renal Cell Carcinoma Extending into the Vena Cava and the Right AtriumJournal of Urology, 1980
- Renel Cell Carcinoma Presenting as Right Atrial Tumor with Successful Removal Using Cardiopulmonary BypassAnnals of Surgery, 1975
- Early Detection of Venous Air Embolism Using a Swan-Ganz CatheterAnesthesiology, 1975
- Removal of Hypernephroma and Inferior Vena CavaArchives of Surgery, 1972
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958