title: Surgical treatment of renal cell carcinoma with inferior vena cava thrombus: using liver mobilization technique to avoid cardiopulmonary bypass.
abstract: OBJECTIVE
  To evaluate the results of surgical treatment of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus and describe the use of a transabdominal approach with liver mobilization to avoid cardiopulmonary bypass (CPB).
  
  
  METHODS
  From February 2002 to January 2006, 109 patients with RCC were surgically treated at Siriraj Hospital. Twelve patients had an IVC thrombus, infrahepatic (level I), retrohepatic (level II), suprahepatic (level III) and intra-atrial (level IV) in one, two, eight and one patient, respectively. Patients' characteristics, pathological features, survival and morbidity were evaluated.
  
  
  RESULTS
  Mean age was 58 years (range, 37-74 years). CPB was used in one patient with level IV thrombus. All patients (92%) with level I-III IVC thrombi underwent successful removal by transabdominal approach without any form of bypass. Mean operative time was 302 minutes (range, 195-420 minutes). The mortality rate was 16% (2 of 12) with sepsis and pulmonary embolism. One patient had colonic injury requiring primary repair. At the mean follow-up of 17 months (range, 3-35 months), of 10 patients, one died due to distant metastases, two were lost to follow-up and seven (60%) were still alive. Five patients (42%) were disease-free at the last follow-up.
  
  
  CONCLUSIONS
  These results support the aggressive surgical removal of RCC with IVC thrombus as the initial treatment. Most of the thrombi can be approached and safely controlled by a transabdominal approach without any form of bypass. Tumour thrombus removal provides a high survival chance and offers improvement in quality of life.
authors.affiliation: Division of Urology, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sittm@mahidol.ac.th
authors.forename: Tawatchai
authors.initials: T
authors.lastname: Taweemonkongsap
authors.forename: Chaiyong
authors.initials: C
authors.lastname: Nualyong
authors.forename: Sunai
authors.initials: S
authors.lastname: Leewansangtong
authors.forename: Teerapon
authors.initials: T
authors.lastname: Amornvesukit
authors.forename: Yongyut
authors.initials: Y
authors.lastname: Sirivatanauksorn
authors.forename: Anupan
authors.initials: A
authors.lastname: Tantiwong
authors.forename: Suchai
authors.initials: S
authors.lastname: Soontrapa
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008099:Liver / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D013927:Thrombosis / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods; D014682:Vena Cava, Inferior