[Diagnosis and surgical management of renal cell carcinoma with inferior vena cava tumor thrombus--a report of 6 cases with literature review].
OBJECTIVE
The management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus is difficult in clinical practice. Complete surgical removal of the primary tumor with its extension along the IVC is the only hope for a potential cure. The diagnosis of vena caval invasion, especially the determination of tumor thrombus extension, is important for surgical approach planning. This report was to summarize our experiences on treating RCC with IVC tumor thrombus, and explore the diagnosis and surgical management.


METHODS
Clinical data, including preoperative diagnosis, operation pattern, and prognosis, of 6 RCC patients with IVC tumor thrombus, treated from 2000 to 2004 in our hospital, were reviewed retrospectively.


RESULTS
Diagnoses of the 6 cases of RCC with IVC tumor thrombus were made by ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI) preoperatively. Of the 6 cases, 1 was renal vein thrombus, 3 were infrahepatic thrombus, 2 were hepatic thrombus. Operations were performed for all 6 patients with 5 successes except 1 death during the operation. The patients were followed-up for 3-30 months after operation; 2 died of distant metastases 3 and 9 months after operation, and the other 3 survived disease-freely.


CONCLUSIONS
CT and MRI are the best ways to diagnose RCC with IVC tumor thrombus. Surgical treatment is the preferred approach for the patients without distant metastases and lymph node involvement. Surgical strategy depends on the tumor thrombus extension and the vena wall involvement status.
Department of Urology, Sir Run Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou, Zhejiang, 310016, PR China.
Xin-De
XD
Li
Sheng
S
Cheng
Xue-Fang
XF
Rui
Gong-Hui
GH
Li
Yue-Bing
YB
Chen
Da-Min
DM
Yu
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology*; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery*