Purpose: We reviewed our experience of the resection of renal tumors i
nvolving the inferior vena cava (IVC) from 1987 to 1992 with the hypot
hesis that retrohepatic IVC involvement of renal tumors can be managed
without cardiopulmonary bypass (CPB) and circulatory arrest with acce
ptable morbidity and mortality rates. Methods: We retrospectively revi
ewed our experience of radical nephrectomies for renal tumors from 198
7 to 1992 (n = 69). Of these, 13 had involvement of the NC (19%). Thre
e of the patients had right atrial extension requiring CPB with circul
atory arrest. Three patients had retrohepatic involvement, and seven h
ad infrahepatic involvement. Ah thirteen patients underwent operative
removal of the tumor and tumor thrombus. Results: The patients with at
rial extension who were treated with CPB and circulatory arrest had ho
spital and 1-year survival rates of 100% (three of three). The patient
s with retrohepatic extension treated without CPB and circulatory arre
st had hospital and 1-year survival rates of 100% (three of three). Th
e patients with infrahepatic extension treated without CPB and circula
tory arrest had hospital and 1-year survival rates of 85% (six of seve
n) and 50% (three of six), respectively. There was no statistically si
gnificant difference between groups. The hospital death occurred in a
patient who had a massive pulmonary embolism and disseminated intravas
cular coagulation before operation. The deaths that occurred before 1
year were due to metastatic disease and unresectable disease at the ti
me of operation. Conclusion: CPB with circulatory arrest is not requir
ed in patients with retrohepatic NC extension of renal tumors, and agg
ressive resection can be performed in these patients with acceptable m
orbidity and mortality rates.