[Inferior vena cava thromboses in renal cancers. 20 years' experience]

The authors present a detailed review of a personal series with careful evaluation of the level of the caval thrombus as far as the right auricle, the degree of lymph node involvement, the surgical treatment and the duration of survival. In contrast with earlier rather optimistic papers, this study revealed a generally poor prognosis. The authors consider that when the cancer has invaded the vena cava, distant microscopic metastases are already present at the time of operation. In the absence of an effective chemotherapy, this type of surgery should only be performed in carefully selected cases (good general health, no signs of metastases or lymph node involvement). In cases with supradiaphragmatic thrombus, cardio-pulmonary by-pass, which is now a common procedure, appears to be safest technique.