INVOLVEMENT OF THE INFERIOR VENA-CAVA BY RENAL TUMOR - SURGICAL EXCISION USING HYPOTHERMIC CIRCULATORY ARREST

Objective To evaluate the immediate and long-term results of a radical surgical technique in the treatment of renal tumours with extensive i nvolvement of the inferior vena cava (IVC). Patients and methods Seven patients with extensive involvement of renal tumours into the IVC wer e operated upon using a cardiopulmonary by-pass, hypothermia and cardi ac arrest to facilitate surgery. Wide exposure of the IVC in a bloodle ss field permitted complete removal of all visible tumour in each case . Histological sections confirmed renal cell cancer in six patients an d Wilms tumour in a 15-year-old girl. Results All patients recovered w ell from their surgery with no major complications and spent one or tw o days in the Intensive Treatment Unit and an average of 13 days in ho spital after the operation. Of the seven patients, four are alive and well with no obvious disease after an average follow-up time of 30 mon ths (range 8-54). The other three patients have died from disseminated renal cancer. Conclusion This procedure provides good local control o f the tumour and offers the only hope of cure in patients with this di sease. In collaboration with the surgical cardiac team it can be safel y carried out with acceptable morbidity and mortality.