[Extended surgery of renal cell carcinoma--its significance and limitation]

Extended surgery was divided into 4 types per below. (1) Extended local resection (1 case). Resection of descending colon and splenectomy were performed in a case with invading left renal cancer. The patient died of cancer in 9 months. Three other cases with locally invading renal cancer were inoperable because of multiple metastases or poor general condition. (2) Thrombectomy in vena cava inferior (6 cases). Successful thrombectomy was carried out in 5 of our 6 cases. All the cases died of metastases of cancer within 4 years. In the literature, long survival is reported after complete resection of thrombus. (3) Resection of distant metastases (11 cases). Palliative surgery was performed in 5 cases with symptomatic brain metastases. After radical resection of solitary metastases, 2 died of cancer, 2 are alive with cancer and the remaining 2 are alive with no evidence of disease (NED). (4) Surgery for contralateral kidney (4 cases). Partial nephrectomy or enucleation of tumor was undertaken in 3 cases (2 NED, 1 death). In the 4th case, as the tumor appeared to invade deeply in the renal parenchyma, ex vivo partial nephrectomy followed by autotransplantation was done (NED). The results indicate that the minimum requirement for radicality should be complete extirpation of the tumor mass and that the indication for radical extended surgery includes presumably resectable intracaval thrombus, solitary metastases and contralateral renal tumor.