title: Nephrectomy and vena caval thrombectomy in patients with metastatic renal cell carcinoma.
abstract: OBJECTIVE
  To report out experience with performing nephrectomy and vena caval thombectomy in patients with metastatic renal cell carcinoma.
  
  
  METHODS
  A retrospective review was performed of 15 patients who underwent surgical excision of the primary tumor and a caval thrombus and treatment of concurrent metastases between 1989 and 1995. The sites of metastases included lungs (n = 8), bone (n = 3), bulky retroperitoneal or mediastinal lymph nodes (n = 2), liver (n = 1), and contralateral adrenal (n = 1). The level of caval involvement was suprahepatic in 3 cases, retrohepatic in 2 cases, and infrahepatic in 10 cases. Three patients had an Eastern Cooperative Oncology Group performance score of 0, 11 had a score of 1, and 1 had a score of 2. Median follow-up was 17 months.
  
  
  RESULTS
  Median operative time was 6.5 hours and median hospitalization was 10 days. Two patients required re-exploration for postoperative hemorrhage. There were no perioperative deaths. Four patients underwent surgery for resection of solitary metastases (1 lung, 2 spine, and 1 humerus); 2 of the 4 received adjuvant radiotherapy. Two patients received biologic therapy preoperatively, 3 received it both preoperatively and postoperatively, and 6 received it only postoperatively. The median time to initiation of postoperative biologic therapy was 48 days (range 25 to 110). Eleven patients are currently alive, 7 with no evidence of disease at a median follow-up of 17 months (range 6 to 66) and 4 with stable metastases at 14 months (range 4 to 22). Ten of the 13 symptomatic patients had improved performance scores after surgery. Four patients have died from metastatic disease: 2 from rapid progression at 2 and 5 months after surgery and the other 2 at 17 and 42 months.
  
  
  CONCLUSIONS
  Nephrectomy and vena caval thrombectomy can be safely performed in selected patients with metastatic disease. Furthermore, in patients receiving biologic therapy, nephrectomy may enable a better quality of life and prolonged survival.
authors.affiliation: Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Slaton
authors.forename: M D
authors.initials: MD
authors.lastname: Balbay
authors.forename: D A
authors.initials: DA
authors.lastname: Levy
authors.forename: L L
authors.initials: LL
authors.lastname: Pisters
authors.forename: J C
authors.initials: JC
authors.lastname: Nesbitt
authors.forename: D A
authors.initials: DA
authors.lastname: Swanson
authors.forename: C P
authors.initials: CP
authors.lastname: Dinney
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy; D012189:Retrospective Studies; D015996:Survival Rate; D014682:Vena Cava, Inferior