title: Surgical Management and Outcome of Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus.
abstract: BACKGROUND
  The authors of this paper assessed the surgical management and outcome of renal cancers when tumor thrombus extended into the inferior vena cava (IVC).
  
  
  METHODS
  From 2000 to 2015, 46 radical nephrectomies were performed on patients with tumor thrombus in the IVC. The mean age of the patients was 60 ± 11 years. Radical nephrectomy and thrombectomies were performed in a single session. There were 18 level-IV, 23 level-III, and 5 level-II tumor thrombi. The operations were performed using cardiopulmonary bypass in 14 patients, while deep hypothermic cardiac arrest was carried out in 4 cases.
  
  
  RESULTS
  The mean size of the tumors was 9.4 ± 3.5 cm. Histology showed the tumor stages to be pT3b in 21cases, pT3c in 22, and pT4 in 3 patients. The mean follow-up period of the patients was 3.6 ± 3.0 years. During the follow-up period, local recurrence was observed in 7 patients, while distant metastases occurred in 8 cases. The median time to progression was 37 ± 27 months. The 5-year overall survival was 43.7%.
  
  
  CONCLUSIONS
  Radical nephrectomy and thrombectomy provided reasonable long-term survival for patients with renal cancer and IVC thrombus. However, tumor progression was detected in 41.6%. The presence of tumor thrombus had a negative effect on tumor progression and survival.
authors.affiliation: Department of Cardiac Surgery, University of Debrecen, Debrecen, Hungary.
authors.forename: Akos
authors.initials: A
authors.lastname: Berczi
authors.forename: Tibor
authors.initials: T
authors.lastname: Flasko
authors.forename: Tamas
authors.initials: T
authors.lastname: Szerafin
authors.forename: Ben
authors.initials: B
authors.lastname: Thomas
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Bacso
authors.forename: Csaba
authors.initials: C
authors.lastname: Berczi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Inferior vena cava; Renal cancer; Thrombus level; Tumor thrombus