PREOPERATIVE COMPUTERIZED-TOMOGRAPHY DETECTION OF EXTENSIVE INVASION OF THE INFERIOR VENA-CAVA BY RENAL-CELL CARCINOMA - POSSIBLE INDICATION FOR RESECTION WITH PARTIAL CARDIOPULMONARY BYPASS AND PATCH GRAFTING

The relationship of the diameter of the inferior vena cava as measured by computerized tomography (CT) and tumor invasion of the inferior ve na caval wall was determined in patients with renal cell carcinoma. In addition, the indications and usefulness of surgery using partial car diopulmonary bypass and a polytetrafluoroethylene (Gore-Tex) patch gra ft are discussed. In all 7 patients with an inferior vena caval diamet er of 40 mm. or larger on CT tumor had extensively invaded the vessel wall macroscopically and microscopically. Therefore, resection of the inferior vena caval wall and repair with a patch graft were necessary. Partial cardiopulmonary bypass was used in 6 of these 7 patients. On the other hand, of 11 patients with an inferior vena cava less than 40 mm. in diameter only 2 with extensive tumor invasion of the vessel wa ll underwent a patch graft procedure without partial cardiopulmonary b ypass. One patient who had massive hemorrhage before bypass was starte d died while in a coma. The survival of the remaining patients ranged from 6 to 131 months (median 19 months). Blood loss in patients who un derwent surgery with partial cardiopulmonary bypass was much less than that in patients without bypass. In our series, there were no complic ations related to the graft itself and graft patency was excellent. Ou r results indicate that an inferior vena caval diameter of 40 mm. or m ore on CT probably indicates extensive tumor invasion. Although furthe r experience and observation are necessary to evaluate whether partial cardiopulmonary bypass and/or a patch graft improves the prognosis of patients with extensive inferior vena caval invasion by renal cell ca rcinoma, this method was relatively safe and decreased blood loss.