title: Tumor thrombus involving the inferior vena cava in renal malignancy: is there a difference in clinical presentation and outcome among right and left side tumors?
abstract: OBJECTIVE
  Renal cell carcinoma (RCC) has a propensity to propagate into the renal vein and inferior vena cava (IVC). Due to inherent differences in the venous anatomy of the right and left kidneys, tumor thrombus involvement of IVC may vary. The aim of this study is to compare clinical presentation and outcome of right vs. left RCC with IVC thrombus.
  
  
  METHODS
  Patients who underwent radical nephrectomy and IVC thrombectomy between 1997 and 2008 were identified. All relevant data were collected and analyzed.
  
  
  RESULTS
  Eight-seven patients were included. Sixty patients (69%) had a right sided tumor. Mean tumor size was 10.2 (+/- 4) cm and was not significantly different on either side. Fifty-six percent of right sided tumors had level-III (intra-hepatic) or higher tumor thrombus, while 22% of left sided tumors had similar level thrombus extension (p < 0.0001). Nearly 50% of left sided tumors showed level-I thrombus compared to 10% of right side tumors. A comparison of age, estimated blood loss and transfusion rate was not significantly different. The recurrence free (p = 0.9) and disease specific survival (p = 0.4) were not significantly different between the right and left side tumors with IVC thrombus.
  
  
  CONCLUSIONS
  A level-III IVC tumor thrombus is more frequently seen with a right side tumor. However, clinical and operative characteristics among the left and right sided tumors with IVC thrombus were not different. More significantly, recurrence rate and survival did not differ with the laterality of the tumor.
authors.affiliation: Department of Urology, Miller School of Medicine, University of Miami, Miami, Florida 33101 , USA.
authors.forename: Devendar
authors.initials: D
authors.lastname: Katkoori
authors.forename: Manoharan
authors.initials: M
authors.lastname: Murugesan
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Mark S
authors.initials: MS
authors.lastname: Soloway
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009392:Nephrectomy; D012189:Retrospective Studies; D017131:Thrombectomy; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery