1986 Volume 77 Issue 8 Pages 1288-1295
Between 1969 and September 1985, 133 patients with renal cell carcinoma were evaluated and treated at our institution. Of these 11 (8.27%) had an involvement of the inferior vena cava by tumorous extension of the tumor. They were 8 men and 3 women, ranging in age from 41 to 67 years (mean 58.9 years).
The affected side was right in 9 patients and left in 2 patients, with a prevalence of the right side. Clinical signs of the presence of a vena caval thrombus were noted in 5 patients, which were leg edema in 4 and varicocele in 2.
Diagnostically, vena cavography by way of either inferior or superior route offered a valuable aid to evaluate the caval involvement and its extent, although in the recent series computerized tomography (CT) has been playing a major role for that purpose.
In 6 patients transabdominal radical nephrectomy was carried out, wherein cavotomy and thrombectomy with simultaneous partial caval resection was also performed in 4 patients. There was 1 operative death probably due to pulmonary embolism. Another complication was a transient renal dysfunction observed in 1 case.
Four of 5 patients with known preoperative metastases died within 10 months and another case is still alive at 4 months.
Of 6 patients without metastasis in whom successful radical nephrectomy and thrombectomy was achieved, 4 were alive with no evidence of the disease 4 months to 7 yerars postoperatively. Consequently, aggressive surgery should be considered in patients with renal cell carcinoma with a sole spread to the vena cava.
