Prosthetic replacement of the inferior vena cava in renal cell carcinoma surgery

An aggressive surgical approach is needed in cases of renal cell carcinoma with extension into the vena cava, since caval extension is not such a bad prognostic indicator as previously believed. Improvements in peri- and intra-operative management have enabled the resection of the tumor thrombus at all levels of the caval extension with acceptable morbidity and mortality. In cases where there is direct major invasion of the venal caval wall, we recommended complete resection of the involved segment and re-establishment of caval continuity using a polytetrafluorethylene (PTFE) interposition graft. Two cases, in whom segmental caval resection was necessary, are reported. The pre- and intra-operative considerations are discussed together with support for the use of PTFE as the graft of choice.