title: Treatment of caval vein thrombosis associated with renal tumors.
abstract: BACKGROUND
  Renal carcinoma represents 3% of all solid tumors and is associated with renal or inferior caval vein (IVC) thrombosis between 2-10% of patients, extending to right atrial in 1% of cases.
  
  
  METHODS
  This is a retrospective study that comprises 5 patients who underwent nephrectomy and thrombectomy by laparotomy because of renal tumor with IVC thrombosis level iii.
  
  
  RESULTS
  Four patients were males and one was female, and the mean age was 57,2 years (range: 32-72). Most important clinical findings were hematuria, weight loss, weakness, anorexia, and pulmonary embolism. Diagnostic confirmation was performed by CT scanner. Metastatic disease was diagnosed before surgery in 3 patients. Suprahepatic caval vein and hepatic hilium (Pringle's maneouver) were clamped in 4 patients, and ligation of infrarrenal caval vein was carry out in one patient. Five patients developed mild complications (Clavien I/II). No patient died and the mean hospital stay was 8,6 days. All patients were treated with chemotherapy, and 3 died because distant metastasis, but 2 are alive, without recurrence, at 5 and 60 months, respectively.
  
  
  CONCLUSIONS
  Nephrectomy and thrombectomy in renal tumors with caval thrombosis can be curative in absence of metastasis or, at less, can increase survival or quality of live. Then these patients must be treated in liver transplant units because major surgical and anesthesiologic expertise. Adjuvant treatment with tyrosin kinase inhibitors must be validate in the future with wider experiences.
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España. Electronic address: carlos.jimenez@inforboe.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Jiménez-Romero
authors.affiliation: Servicio de Cirugía General, Hospital Universitario Lucus Augusti, Lugo, España.
authors.forename: María
authors.initials: M
authors.lastname: Conde
authors.affiliation: Servicio de Urología, Hospital Doce de Octubre, Madrid, España.
authors.forename: Federico
authors.initials: F
authors.lastname: de la Rosa
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Manrique
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Jorge
authors.initials: J
authors.lastname: Calvo
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Óscar
authors.initials: Ó
authors.lastname: Caso
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Muñoz
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Marcacuzco
authors.affiliation: Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Hospital Universitario Doce de Octubre, Universidad Complutense de Madrid, Madrid, España.
authors.forename: Iago
authors.initials: I
authors.lastname: Justo
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D009392:Nephrectomy; D012189:Retrospective Studies; D017131:Thrombectomy; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000601:surgery*
keywords: Caval thrombosis; Caval vein; Renal tumor; Trombo tumoral; Trombosis de cava; Tumor renal; Tumoral thrombus; Vena cava