title: [Morbidity and mortality of renal cancer with inferior vena cava extention according to various types of surgical management].
abstract: OBJECTIVE
  The objective of this study was to evaluate the mortality and morbidity of patients operated for renal cancer with inferior vena cava extension according to the surgical management and the upper limit of the tumour thrombus. underwent radical nephrectomy with resection of neoplastic venous thrombus extending into the inferior vena cava. The upper limit of the tumour thrombus was below the hepatic veins in 21 cases (52.5%) and above the hepatic veins in 19 cases (47.50%) with invasion of the right atrium in 6 cases (150).
  
  
  RESULTS
  Cardiopulmonary bypass (CPB) was used in 12 patients (30%). The transfusion rate was 87.5%. In the group of 19 patients with thrombus extending above the hepatic veins, the transfusion rate was lower in patients operated by CPB (p=0.008). Intraoperative embolism occurred in 3 patients (7.5%): 2 cases of thrombotic embolism and 1 case of gas embolism, always in patients operated without CPB. The early mortality was 7.5% from haemorrhagic complications. The early morbidity was 47.5%. No significant difference was observed between groups of patients operated with or without CPB in terms of morbidity (p=0.836) or mortality (p=0.896).
  
  
  CONCLUSIONS
  The management of patients with renal cancer and inferior vena cava extension is complicated and requires a multidisciplinary approach. Patients operated under CPB for tumours extending above the hepatic veins have a lower transfusion rate and a lower embolic complication rate with no increase of mortality and morbidity.
authors.affiliation: Clinique Urologique, Hôtel Dieu, Nantes, France. jrigaud@chu-nantes.fr
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rigaud
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Hetet
authors.forename: Guillaume
authors.initials: G
authors.lastname: Braud
authors.forename: Simon
authors.initials: S
authors.lastname: Battisti
authors.forename: Loïc
authors.initials: L
authors.lastname: Le Normand
authors.forename: Pascal
authors.initials: P
authors.lastname: Glemain
authors.forename: Georges
authors.initials: G
authors.lastname: Karam
authors.forename: Olivier
authors.initials: O
authors.lastname: Bouchot
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D014682:Vena Cava, Inferior