title: Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus.
abstract: BACKGROUND
  The successful excision of a renal cell carcinoma (RCC) invading the inferior vena cava (IVC) remains a technical intraoperative challenge and requires a careful preoperative surgical management planning. Although a radical operation remains the mainstay of the therapy for RCC, the optimal management of the patients with RCC causing IVC tumor thrombus remains unresolved. In this study, we reviewed our experience in this group of patients and herein report the results.
  
  
  METHODS
  Between July 1990 and August 1998, 11 patients with RCC with IVC tumor thrombus underwent surgical treatment. The mean patient age was 54.2 years and the male to female ratio was 1.75. The cephalad extension of the tumor was suprarenal in all cases, being infrahepatic in 6 patients, intrahepatic in 2, and suprahepatic with right atrial extension in 3 patients. All tumors were resected via inferior vena cava isolation and, when necessary, extended hepatic mobilization and Pringle maneuver, with primary or patch closure of vena cavotomy. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) were used in 3 patients.
  
  
  RESULTS
  The mortality rate was 9.1% (1 patient was lost on the 11th postoperative day). Complications occurred in 3 patients. The remaining 10 patients (90.9%) could be successfully discharged from hospital. Two of them were lost during follow-up because of tumor progression at the 43rd and 54th postoperative months. The 10-year Kaplan-Meier survival estimate was 71.4%, with a mean follow-up of 4.6 years. The presence of lymph node metastases and perinephric spread seemed to possess an adverse effect on the survival. Although the groups included small numbers of patients, there was no significant difference in survival in regard to the different levels of tumor thrombus extension into the vena cava.
  
  
  CONCLUSIONS
  Surgical treatment is the preferred approach to patients with RCC and IVC tumor thrombi as it provides markedly better results when compared with the other therapeutical modalities. We believe that complete surgical excision of the tumor and the resulting thrombus with appropriate preoperative staging and a well-planned surgical approach, using CPB and DHCA when necessary, provide an acceptable long-term survival with a good quality of life expectation.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey. skaplan@bir.net.tr
authors.forename: Sadi
authors.initials: S
authors.lastname: Kaplan
authors.forename: Sinan
authors.initials: S
authors.lastname: Ekici
authors.forename: Riza
authors.initials: R
authors.lastname: Doğan
authors.forename: Metin
authors.initials: M
authors.lastname: Demircin
authors.forename: Haluk
authors.initials: H
authors.lastname: Ozen
authors.forename: Ilhan
authors.initials: I
authors.lastname: Paşaoğlu
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017131:Thrombectomy / Q000379:methods; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*