MALIGNANT RENAL TUMOR WITH EXTENSION TO THE INFERIOR VENA-CAVA

BACKGROUND: Management of malignant renal tumors involving the inferio r vena cava (IVC) depends on tumor extension within the cava. METHODS: Of 295 patients treated for renal cancer, propagation of tumor mass t hrough the renal vein to IVC was seen in 22 (7%) patients. Cephalad ex tension of the tumor was suprarenal: infrahepatic in 12, retrohepatic in 6, and within the right atrium in 4 patients. All patients had radi cal nephrectomy, cavotomy, and complete resection of tumors except 1 w ith diffuse peritoneal metastasis. RESULTS: Twenty-one patients had cu rative resections. No operative deaths and no instances of pulmonary e mbolism or exsanguination occurred. Seventeen patients were alive at 2 years and 12 at 5 years, resulting in 77% and 55% survival rates, res pectively. CONCLUSIONS: An aggressive approach for vena cava involveme nt from malignant renal neoplasms resulted in prevention of tumor embo lus, minimization of blood loss, and maintenance of venous return to t he heart. Am J Surg. 1998; 176:137-39. (C) 1998 by Excerpta Medica, In c.