TUMOR INFILTRATION OF THE VENA-CAVA IN NEPHROBLASTOMA

Although operative treatment of Wilms' tumors has become more straight forward as a result of advances in preoperative treatment and precise diagnosis, vascular involvement by the tumor can cause serious problem s at operation. These problems can be more easily managed if they have been identified pre-operatively and the level of the intra-vascular t umor thrombus has been defined. In this study we propose a classificat ion of intravascular involvement of Wilms' tumors suggesting the clini cal consequences and operative strategy. In our series of 84 patients we treated 7 (8.3 %) with preoperatively diagnosed intracaval tumor th rombus using ultrasound as the most sensitive non-invasive diagnostic technique. The surgical therapy depends on the stage; stage III and st age IV should be operated in cooperation with the cardiovascular surge on in deep hypothermic circular arrest.