1975 Volume 66 Issue 6 Pages 333-340
The renal cell carcinoma often involves directly the inferior vena cava. The method of the curative treatment for such a case is radical nephrectomy with en bloc resection of the inferior vena cava containing tumor. However, excision of the vena cava extends above the contralateral renal vein, results in passive renal congestion and failure when adequate venous collaterals are not developed.
As one of the surgical methods to cure completely such a case without injuring the function of the remaining kidney, we studied on an resection of the inferior vena cava and on an end-to-side renoportal venous anastomosis.
Using 7 mongrel adult dogs, we resected the left kidney and the inferior vena cava en bloc from above the left suprarenal vein to just above the iliac bifurcation, and made an end-to-side anastomosis between the right renal vein and the portal vein. At the same time, we ligated and divided the left spermatic (or ovarian) vein emptying to the left renal vein, the lumbar vein, the left suprarenal vein and the right spermatic (or ovarian) vein entering the resected vena cava.
Five of these 7 dogs maintained excellent health and were followed up for 12 to 14 months. Two dogs died of bleeding and shock, 6 hours and 17 hours after the operation respectively.
Renal and liver functions of the 5 dogs were examined for 12 to 14 months after operation. The examinations proved that the renal functions (blood urea nitrogen, serum creatinine level, PSP test and excretory pyelography) were normal and proteinuria was negative. In addition microangiogram revealed no irregularity in the vascular system of the kidney and histological examination disclosed that glomeruli and renal tubules were normal.
As liver function tests, alkaline phosphatase, bilirubin, GOT, GPT, and LDH were determined and they were all found normal. Also, histological tests revealed that the liver was normal.
Concerning the collateral blood flow after excision of the inferior vena cava, the vertebral vein, azygos vein, hemiazygos vein, lumbar vein, deep iliac circumflex vein and right suprarenal vein were examined.
Judging from above findings, we consider our method worthy to apply to selected patients, as one of the curative treatments for the renal cell carcinoma which involves the inferior vena cava.
