Surgical management of renal cell carcinoma with inferior vena cava thrombus

Abstract

AimThe aim of the present study was to evaluate the short‐term outcome of renal cell carcinoma with inferior vena cava (IVC) thrombus treated by radical nephrectomy and IVC thrombectomy.Patients and MethodsTen consecutive patients who underwent surgery for renal cell carcinoma with IVC thrombus between August 2008 and November 2011 were studied retrospectively in terms of clinical presentation, intraoperative details, surgical approaches, pathology and outcomes.ResultsTen patients were treated surgically for renal cell carcinoma. They all had renal vein and IVC involvement (Neves–Zincke classification: level I: n = 1, level II: n = 3, level III: n = 3, level IV: n = 3). The majority presented with gross haematuria (80 per cent) and various degrees of anaemia (70 per cent). Mean operation time was 404 min. Intraoperative blood loss ranged from 400 mL to 13500 mL. One postoperative death was recorded, and intraoperative and postoperative morbidities (tumour thrombus pulmonary embolism, IVC thrombosis, retroperitoneal fluid collection) complicated recovery in four patients. Evidence of disease progression was observed in seven patients (70 per cent) upon follow up.ConclusionRenal cell carcinoma with IVC extension is a challenging disease entity. Despite the technical demand and high morbidity, radical nephrectomy plus IVC thrombectomy can be performed with reasonable outcomes in a local centre with multidisciplinary support.