title: Less invasive treatment option for renal carcinoma with venous tumor thrombus.
abstract: OBJECTIVE
  To retrospectively analyze patients treated by renal tumor and venous tumor thrombus (VVT) removal and to introduce a less stressful and safer surgical method without thoracotomy in Neves level 3 cases.
  
  
  METHODS
  From 2002 to 2011, 33 patients underwent surgery for renal cell cancer combined with tumor thrombus of the inferior vena cava. Preoperative symptoms, tumor-node-metastasis classification of tumors, thrombus extension classified by Neves and Zincke system, types of surgical interventions, complications, postoperative management, and survival results were analyzed.
  
  
  RESULTS
  Ten patients had level 1, 17 had level 2, and 6 had level 3 thrombi according to Neves and Zincke. In 5 patients with level 3 thrombi, the liver was mobilized without thoracotomy and in 1 patient endoluminal occlusion was utilized. There was no intraoperative mortality. The median survival time of 10 patients who died during follow-up period was 36.6 months (range, 0-121 months).
  
  
  CONCLUSIONS
  Renal cell cancer complicated with tumor thrombus without metastasis can be curable by performing a complete resection. The thrombus level determines the surgical approach and method. Our results confirm that level 3 caval vein tumor thrombus can be safely surgically treated by laparotomy with liver mobilization. Thoracotomy, use of cardiopulmonal bypass, and hypothermic circulatory arrest can be avoided with adequate liver- and vascular surgery methods.
authors.affiliation: Zoltán Nagy, Division Head of General Surgery, Department of Surgery, Bajcsy-Zsilinszky Hospital, Building A, Floor I, Maglódi út 89-91, 1106 Budapest, Hungary, nagyz56@t-online.hu.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Nagy
authors.forename: József
authors.initials: J
authors.lastname: Pánovics
authors.forename: Attila
authors.initials: A
authors.lastname: Szendrői
authors.forename: Attila M
authors.initials: AM
authors.lastname: Szász
authors.forename: László
authors.initials: L
authors.lastname: Harsányi
authors.forename: Imre
authors.initials: I
authors.lastname: Romics
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy / Q000379:methods; D012189:Retrospective Studies; D013908:Thoracotomy; D014682:Vena Cava, Inferior / Q000601:surgery*; D054556:Venous Thromboembolism / Q000209:etiology / Q000601:surgery*