title: [Surgical treatment of renal tumours with venous extension].
abstract: OBJECTIVE
  Renal carcinoma accounts for 3% of malignant urological tumors. The existence of tumor thrombus in the venous system is more infrequent, and, despite it was believed until recently its presence worsened the diagnosis of the disease, currently it is accepted that in the absence of metastatic or lymph node disease, surgery is the treatment of choice and potentially curative for these tumors.
  
  
  METHODS
  Between June 2003 and November 2007 eight patients with renal disease and venous thrombus underwent surgery; two of them wereT3c and six T3b; in five of them surgery was carried out in association with the heart surgery team in our centre. Three of them underwent surgery with extracorporeal circulation. Mean patient age was 56 years.
  
  
  RESULTS
  Tumor thrombus was grade I in one patient, grade II in 4 patients, grade III in one patient, and grade IV in two patients. In all patients with tumor grade > or = III, as well as two with grade II, surgery was performed in conjunction with the department of heart surgery. The operation with extracorporeal circulation, deep hypothermia, cardioplegia, and antegrade and retrograde brain perfusion was performed in grades III and IV. Midline incision was performed, with or without sternotomy, depending on the level of the thrombus. Hemorrhage was the most frequent perioperative complication.
  
  
  CONCLUSIONS
  It is essential to know the exact level of the cephalic extreme of the tumor thrombus to design the proper surgical strategy; for that, we can use MRI, CT scan or ultrasound. Therefore, surgical approach, multidisciplinary cooperation and use of extracorporeal circulation will depend on such extension of the thrombus and concurrent factors of the patient. A good surgical strategy, as well as early surgery may avoid the use of venous filters preoperatively.
  
  
  CONCLUSIONS
  Venous wall invasion seems to be related with a greater incidence of lymph node disease, but these patients are candidates to intention-to-cure radical surgery. Thrombus level is not a prognostic factor per se, but it should be taken into consideration for surgical planning. After radical surgery survival rates achieved are similar to those of tumors without venous thrombus.
authors.affiliation: Servicio de Urología, Consorcio Hospital General Universitario de Valencia, Valencia, España. chimojuan@hotmail.com
authors.forename: Joaquín Ulises
authors.initials: JU
authors.lastname: Juan Escudero
authors.forename: Macarena
authors.initials: M
authors.lastname: Ramos de Campos
authors.forename: Pedro
authors.initials: P
authors.lastname: Navalón Verdejo
authors.forename: Sergio
authors.initials: S
authors.lastname: Cánovas López
authors.forename: Milagros
authors.initials: M
authors.lastname: Fabuel Deltoro
authors.forename: Francisco
authors.initials: F
authors.lastname: Serrano de la Cruz Torrijos
authors.forename: Francisco
authors.initials: F
authors.lastname: Ramada Benlloch
authors.forename: Emilio
authors.initials: E
authors.lastname: Marques Vidal
authors.forename: Juan
authors.initials: J
authors.lastname: Martínez León
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D012082:Renal Veins; D014682:Vena Cava, Inferior