[Intravenous tumor invasion in renal cancer]

Intravenous tumor invasion occurred in 84 out of 600 patients who had been operated on for carcinoma of the kidney. The inferior vena cava was thrombosed by a tumor in 54 patients. Ultrasonic examination, computed tomography, and venocavography were used in establishing the diagnosis of intravenous invasion. It is stressed that information on the upper border of the thrombus in the inferior vena cava must be obtained before the operation, and that in block on the inferior cavogram transatrial venocavography is absolutely indicated. The presence of absence of growth of intracaval tumor masses into the wall of the inferior vena cava is an important moment determining peculiarities of the operation. In the authors experience such invasion was encountered in 30% of patients. Fifty-two patients had subdiaphragmatic thrombosis of the inferior vena cava and 2 patients had supradiaphragmatic thrombosis. In addition to radical nephrectomy, 28 patients underwent resection of the lateral surface of vena cava inferior, 17--thrombectomy from vena cava inferior, and 8--resection of a segment of this vein. Postoperative lethality was 9.5%, 5-year survival was 40.8%. It was found that venous invasion without growth of the tumor into the fibrous capsule of the kidney and without lymphogenous and distant metastases has no negative effect on the prognosis if the tumor masses had been removed completely from vena cava inferior. The authors believe operations on patients with renal carcinoma and venous tumor invasion in stages T2N0M0, T3N0M0 and T2-3N1-2M0 to be advisable.