VENOUS INVASION BY RENAL-CELL CARCINOMA - SURGICAL TECHNIQUE, COMPLICATIONS AND SURVIVAL RATE

Renal cell carcinoma invades the vena cava in 4-10% of cases. Another 10% of patients present with invasion of the renal vein. The surgical approach, complications and long-term outcome of 95 patients were inve stigated. Intraoperative complications occurred in 1 of 73 patients wi th involvement of the renal vein and 5 of 22 patients with vena cava t hrombus. One patient in each group died due to pulmonary emboli in the perioperative period. Minor renal insufficiency occurred in 39 (54.2% ) and 11 (50%) of the patients respectively. The rates of minor compli cations such as wound infections, haematoma and pneumonia were similar in the two groups. The mean intra-operative blood loss of 780 mi in p atients undergoing tumour nephrectomy was significantly lower than the blood loss of 1485 mi in patients with tumour thrombus extension into the vena cava. The 5-year survival rate of patients with V1 tumours ( 71%) is comparable to that of patients without venous involvement. Tum our extension into the vena cava (V2) influences the 5-year survival r ate significantly, decreasing it to 56.7%. In conclusion, long-term su rvival can be achieved for patients with renal cell carcinoma and veno us involvement, though for patients with lymph node metastases or dist ant metastases only short-term palliation can be achieved. However, th e potential benefits should be carefully weighed against the possible complications, the surgical morbidity and the resources expended in ve na cava resection.