Abstract
From 1985 to 1999, 24 cases of malignant tumors (renal carcinoma (17), adrenal carcinoma (2), hepatocellular carcinoma, leiomyosarcoma, paraganglioma and Wilms tumor respectively (1 each) with inferior vena caval invasion were treated surgically. Of these, 17 cases (14 men and 3 women), 47～78 years old (mean age 61.6) of advanced renal cell carcinomas involving the inferior vena cava, underwent radical nephrectomy and removal of the tumor thrombi. Vena caval tumor thrombus associated with renal cell carcinoma occurs in 4 to 10% of all renal tumors. Radical nephrectomy with vena caval thrombectomy represents the only realistic chance for cure for patients with renal cell carcinoma that has extended into the inferior vena cava.
We operated on these cases using two main methods. One was the simple vena caval incision method (SVCI), the other was the cardiopulmonary bypass and hypothermic (25℃) circulatory arrest method (CPBA). In all cases, the primary tumor and thrombi were completely removed. Ten out of the 17 patients who underwent operative removal of the tumor and tumor thrombi by various methods were survived (58.8%). The maximal long term survival was 163 months. The operation time and transfusion requirement were slightly higher for CPBA than for SVCI, but there was no statistically significant difference between the two methods. The results of both methods for surgical resection of renal carcioma extending into the inferior vena cava were satisfactory. We conclude that CPBA facilitates the excision of renal carcinoma with a higher level of tumor thrombi in the inferior vena cava (Novick’s classification levels 3 and 4).
Aggressive resection can be performed with acceptable morbidity and mortality rates in these patients.
