MANAGEMENT OF RENAL TUMORS INVOLVING THE INFERIOR VENA-CAVA

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.