Surgical management of renal cell carcinoma invading the inferior vena cava

The aim of the study was the evaluation of long-term outcome and prognosis of the patients with renal cell carcinoma (RCC) extending into the inferior vena cava (IVC). Influence of the patient, tumor characteristics and therapeutic interventions on the disease prognosis was also assessed. 24 patients (19 male and 5 female) with RCC extending into the IVC underwent surgical treatment at our institution between 1990 and 2002. The mean patient age was 58.2 years (range: 38-78 years). The level of tumor extension was infrahepatic (level I) in 16 (67%), intrahepatic (level II) in 6 (25%) and suprahepatic without atrial invasion (level III) in 2 (8%) patients. All the tumors were resected via inferior vena cava; median sternotomy with a control of supradiaphragmatic IVC without cardiopulmonary bypass and hypothermia was performed in two cases. Mortality rate was 7.5 %. Complications occurred in 6 patients (25 %). The 5-year Kaplan-Meier survival estimate was 65%, with a mean follow-up of 49.6 months (range: 10-152 months). The tumor grade, radicality of tumor excision and symptoms at the disease presentation (systemic vs. local) were the factors associated with the disease-free survival (p=0.02, 0.002 and 0.03, respectively). There was no significant difference in survival with regard to the level of thrombus extension into the vena cava (p=0.3) Surgical treatment is preferred option in the patients with RCC and IVC tumor thrombus as it provides markedly better results as compared with other therapeutic modalities. The complete surgical excision of the primary RCC and the tumor thrombus with appropriate preoperative staging and surgical technique provides an acceptable long-term patient survival with a good quality of life.