RADICAL NEPHRECTOMY IN PATIENTS WITH RENAL-CELL CARCINOMA WITH VENOUS, VENA-CAVAL, AND ATRIAL EXTENSION

BACKGROUND: From July 31, 1968, through August 31, 1992, 100 patients with renal cell carcinoma extending into the renal vein, vena cava, an d right atrium were treated and evaluated at our institution. Each pat ient underwent radical nephrectomy with vena cavotomy and atriotomy as considered to be appropriate for each individual patient's tumor thro mbus. METHODS: The charts were retrospectively analyzed, and surveys w ere sent to survivors or nearest of kin. RESULTS: The median age was 6 1 years, and two thirds of the tumors occurred in men (67 cases). Of t he 100 patients with renal cell carcinoma resected, 13 patients (13%) had atrial extension: 75 patients (75%) had vena caval extension; and 12 patients (12%) had extension only into the renal vein. Seventy-two patients (72%) had no evidence of metastatic disease at the time of su rgery and have a median survival of 21.1 years. Five-year survival is 64%, and 10-year survival is 57%. Twenty-eight patients (28%) had evid ence of metastatic intraoperative and/or pathologically proven metasta tic disease and have a median survival of 2.5 years with a 5-year surv ival of 20% and no patient living beyond 7.8 years. CONCLUSION: We bel ieve that an extended operation for renal cell cancer with involvement of the renal vein, vena cava, and right atrium is warranted in proper ly selected patients and ensures reasonable long-term survival.