title: Renal cell carcinoma with inferior vena cava thrombus: the Hacettepe experience.
abstract: OBJECTIVE
  We evaluated the clinical outcome and factors affecting survival in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC).
  
  
  METHODS
  Between 1990 and 2007, 28 patients with RCC and tumor thrombus extending into IVC underwent radical nephrectomy and thrombectomy. Patient data were reviewed retrospectively to evaluate the demographics, clinical presentation, surgical approach, pathological features, clinical outcomes, and survival.
  
  
  RESULTS
  Twenty-eight patients with a mean age of 52.7 years were operated. Thrombus level was infrahepatic in 15 patients (54%), intrahepatic in 3 patients (10%), suprahepatic in 3 patients (10%), supradiaphragmatic in 2 patients (8%), and intracardiac in 5 patients (18%). All patients with intracardiac thrombi underwent cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). The mean tumor size was 98.21 mm. Four patients had distant metastases and 3 patients had lymph node involvement. Pathological examination revealed RCC of clear cell type in 26 patients, papillary in 1 and chromophobe in 1 patient. At a mean follow-up of 36.4 months, 16 patients were still alive while 8 patients died due to disease progression and 2 patients died of other causes. Two patients died of pulmonary emboli in the early postoperative period. Lymph node involvement, distant metastases, hypercalcemia, and sarcomatoid component were found to be factors affecting overall survival significantly. Level of tumor thrombus and Fuhrman grade did not affect survival.
  
  
  CONCLUSIONS
  Radical nephrectomy and tumor thrombectomy is currently known to be the most effective method in patients with RCC and tumor thrombus extending into IVC. Factors affecting survival are the ones related to tumor biology. Tumor thrombus level does not affect the prognosis.
authors.affiliation: Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Sertac
authors.initials: S
authors.lastname: Yazici
authors.forename: Kubilay
authors.initials: K
authors.lastname: Inci
authors.forename: Cenk Yucel
authors.initials: CY
authors.lastname: Bilen
authors.forename: Ahmet
authors.initials: A
authors.lastname: Gudeloglu
authors.forename: Bulent
authors.initials: B
authors.lastname: Akdogan
authors.forename: Dilek
authors.initials: D
authors.lastname: Ertoy
authors.forename: Volkan
authors.initials: V
authors.lastname: Kaynaroglu
authors.forename: Metin
authors.initials: M
authors.lastname: Demircin
authors.forename: Haluk
authors.initials: H
authors.lastname: Ozen
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D012189:Retrospective Studies; D017131:Thrombectomy; D013927:Thrombosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D014682:Vena Cava, Inferior / Q000473:pathology* / Q000601:surgery