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Renal cell carcinoma extending to the renal vein and inferior vena cava: Results of surgical treatment and prognostic factors
Author(s) -
Tongaonkar Hemant B.,
Dandekar Niteen P.,
Dalal Amish V.,
Kulkarni Jagdeesh N.,
Kamat Murali R.
Publication year - 1995
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930590205
Subject(s) - medicine , inferior vena cava , nephrectomy , thrombus , renal vein , renal cell carcinoma , surgery , adipose capsule of kidney , radiology , carcinoma , vein , kidney
Abstract Forty‐seven patients with renal cell carcinoma with tumor thrombus extension to the renal vein or inferior vena cava (IVC) were treated surgically over a 10‐year period. There were 41 males and 6 females with a mean age of 45.7 years. Thirty‐three patients had right‐sided and 14 had left‐sided tumors. Patients with renal vein or infrahepatic IVC thrombus were treated with radical nephrectomy with tumor thrombus excision after achieving conventional vascular control over the IVC and the opposite renal vein. Four patients with retrohepatic IVC thrombus were treated with venacavotomy and thrombectomy after achieving vascular control above the thrombus but below the hepatic veins while two other patients with retrohepatic and one with suprahepatic thrombus required a bifemoroatrial partial venous bypass prior to tumor thrombectomy. There was one postoperative death due to pulmonary embolism. The actuarial 5‐year survival for all patients with venous extention was 50% and the median survival was 4.35 years. Perinephric spread and lymph node metastases were significant prognostic factors affecting survival. This suggests that it is the locoregional spread of renal cell carcinoma rather than the level of the thrombus which governs the prognosis of patients with tumor thrombus extension to the renal vein or IVC.