[Renal cell carcinoma with vena cava involvement. Surgical strategies and results]

The elaboration of new operative procedures established in the last decade has led to an improved prognosis in patients with renal cell carcinoma with vena caval extension. We report on our personal operative experience in over 100 patients and present the current analysis of 76 patients with renal carcinoma with vena caval extension seen in our institution between 1985 and 1996. Sixty-six patients underwent nephrectomy and removal of vena caval tumor thrombi. Actuarial 5-year survival for patients without metastasis was 38%. For patients with tumor stages between I and III, 5-year survival was between 40 and 50% and was not significantly related to the rostral extent of the tumor thrombus. The relatively poor outcome for patients with tumor thrombi invading the right atrium was caused by a high perioperative mortality (50%). For patients with distant metastases, medium survival time was 10.5 months, implying that radical surgery is useless in cases of distant metastases.