title: Renal cell carcinoma with inferior vena caval extention: impact of tumour extent on surgical outcome.
abstract: OBJECTIVE
  To evaluate our experience with surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) involvement and examine the relationship between prognosis and tumour extent.
  
  
  METHODS
  A retrospective review of nephrectomy performed between 1985 and 2005 identified 50 patients presenting with tumour thrombus extension into the IVC. Clinical characteristics and outcome were evaluated.
  
  
  RESULTS
  Of the 50 patients evaluated, 7, 26, 10 and 7 presented with level I, II, III and IV thrombus, respectively. Major postoperative complications occurred in 16% of patients. Local or distant failure occurred in 25 (64%) patients. The mean time to recurrence was 10 months. Only supra-diaphragmatic extension of the tumour thrombus was predictive of disease recurrence.
  
  
  CONCLUSIONS
  Locally advanced RCC with IVC thrombus remains associated with significant local and distant failure rate. The level of thrombus extension is significantly associated with disease recurrence. Effective adjuvant therapy is needed to improve outcome in this patient population.
authors.affiliation: Department of Surgery, Division of Urology, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Otaibi
authors.forename: Tamer
authors.initials: T
authors.lastname: Abou Youssif
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Alkhaldi
authors.forename: Kanishka
authors.initials: K
authors.lastname: Sircar
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Armen
authors.initials: A
authors.lastname: Aprikian
authors.forename: David
authors.initials: D
authors.lastname: Mulder
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D017131:Thrombectomy / Q000379:methods*; D013927:Thrombosis / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*