Therapy for kidney cell carcinoma with cava thrombus. Importancy of extracorporeal circulation and prognostic value of cranial tumor extension

In approximately 4-10 % of patients presenting with renal cell cancer the t ransluminal propagation of a tumor thrombus into the vena cava inferior or the right atrium comes to diagnosis. Recent investigations have indicated t hat the presence of neoplastic extension into the venous system does not re veal independent prognostic value regarding the clinical course of the dise ase. Although the complete surgical removal of vena cava thrombosis in pati ents without simultaneously occurring regional lymph node or distant metast ases has become a well established treatment modality, several questions co ncerning this surgical strategy still remain the subject of ongoing discuss ions. In the present investigation that included 92 patients with renal cel l cancer and intracaval neoplastic extension it was clearly demonstrated th at the use of ca cardiopulmonary bypass, deep hypothermia and circulatory a rrest preferably during the removal of intracaval thrombosis extending into the right atrium does not result in a substantially increased treatment-re lated intra- or postoperative mortality. However, in contrast to a previous ly reported observation this treatment option did not reveal any substantia l impact on the long-term survival of the patients following surgical thera py. Accordingly, the cranial extension of intracaval thrombosis was not ide ntified as a biological Variable of any prognostic importance for renal cel l cancer patients.