Dj. Swierzewski et al., RADICAL NEPHRECTOMY IN PATIENTS WITH RENAL-CELL CARCINOMA WITH VENOUS, VENA-CAVAL, AND ATRIAL EXTENSION, The American journal of surgery, 168(2), 1994, pp. 205-209
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.