title: Surgical approach to tumor thrombus of renal cell carcinoma at the level between hepatic vein and diaphragm.
abstract: BACKGROUND
  The curative resection of tumor thrombus of renal cell carcinoma often provides a good prognosis, but the best surgical method for resection at the level between hepatic vein and diaphragm is still a matter of controversy.
  
  
  METHODS
  We performed transabdominal surgery without cardio-pulmonary bypass on 4 patients with tumor thrombus at the level between hepatic vein and diaphragm. The surgical procedures were as follows: The right lobe of the liver was separated and detached from the retroperitoneum, and then the vena cava was clamped just below the diaphragm simultaneous with clamping the porta hepatis. After complete circulatory isolation of the vena cava, the tumor thrombus was resected.
  
  
  RESULTS
  There were no severe complications postoperatively. Two patients died of cancer 18 and 38 months after surgery, and the other 2 are alive without evidence of disease after 62 and 66 months.
  
  
  CONCLUSIONS
  This anatomically rational approach is thought to be a good alternative to the pull-through method or cardio-pulmonary bypass for removing a tumor thrombus at this level.
authors.affiliation: Department of Urology and Surgery, School of Medicine, Chiba University, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Isaka
authors.forename: T
authors.initials: T
authors.lastname: Okano
authors.forename: J
authors.initials: J
authors.lastname: Shimazaki
authors.forename: M
authors.initials: M
authors.lastname: Masuda
authors.forename: M
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D002292:Carcinoma, Renal Cell / Q000098:blood supply* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D003964:Diaphragm; D006503:Hepatic Veins; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply* / Q000473:pathology; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D013927:Thrombosis / Q000473:pathology / Q000601:surgery*; D014684:Venae Cavae / Q000473:pathology