WILMS-TUMORS WITH INTRACAVAL INVOLVEMENT

Since Gross established the basic rules for nephrectomy in Wilms' tumo ur (WT) in 1953, the management of nephroblastoma has been more straig htforward. However, some cases with intravascular involvement, current ly detected by ultrasound (US), may represent a daunting challenge for the surgeon. Inferior vena cava with tumour thrombus induced by WT ca n be asymptomatic and, if undetected, can contribute to poorer prognos is for two main reasons: possible neoplastic cells inside the thrombus and higher morbidity risk of surgery. From 1979 to 1993, 81 WT were s tudied by routine US. Intracaval thrombosis was diagnosed in four (5%) , in one of which the thrombus extended to the right atrium. in our ex perience, the surgical strategy in each of the four cases (100% surviv al) depended on the length of the thrombus and whether or not it infil trated the vena cava wall. If the thrombus can be easily removed: comp lete resection. However, in cases of atrial thrombus, and more particu larly if the thrombus involves the intima, we suggest the thrombus not be touched since the problem may be solved by preoperative and postop erative chemotherapy. Thus the favourable prognosis would be maintaine d and superfluous risky surgery avoided. (C) 1996 Wiley-Liss, Inc.