[Surgical treatment of renal cell carcinoma with extension into the vena cava]

Between 1985 and 1992, 9 patients (6 men and 3 women), 50-76 years old (mean age 63.6), underwent radical nephrectomy and removal of the tumor thrombus for the treatment of renal cell carcinoma extending into the vena cava at the Department of Urology, Hiroshima University Hospital. Seven tumors were located in the right kidney and two in the left kidney. Three tumor thrombi extended into the vena cava within 2 cm (level 1 according to the Novick's classification), 2 extended into the infrahepatic vena cava (level 2), 2 extended into the suprahepatic vena cava (level 3), and other 2 extended into the right atrium (level 4). Two patients had distant metastases preoperatively. The tumor thrombi at the level 1 were removed by venacavotomy with a short duration of surgery and a small amount of blood loss, while in those at the level of 2 or 3, both the duration of surgery and the amount of blood loss increased because the mobilization of the liver needed to remove the thrombi. For removing tumor thrombi at the level 4, cardiopulmonary bypass and deep hypothermic circulatory arrest were applied, resulting in longer duration of surgery but less amounts of blood loss than those at the level 2 or 3. Postoperatively, 2 patients had a renal insufficiency and another 2 had a liver dysfunction. One operative death occurred in this series because of pulmonary embolism.(ABSTRACT TRUNCATED AT 250 WORDS)