Prognosis of renal cell carcinoma with vena caval and renal vein involvement. An update.

In tumor surgery, vascular invasion usually portends a grave prognosis; however, in patients with renal cell carcinoma, aggressive management can achieve survival rates approaching those of contained hypernephroma. This retrospective review of 65 patients treated from 1975 to 1986 has revealed a 28 percent incidence of renal vein and vena caval involvement (each seen alone or in combination per patient), which was significantly higher than previously reported rates (6 to 8 percent). We attribute this to our evaluation of all patients preoperatively with arteriography and subsequent radiography of the vena cava in those suspected of having tumor thrombus in the renal vein, or vena cava, or both. We think arteriographic studies are more sensitive and reliable for assessment of vascular invasion than computerized tomography. There was a 100 percent follow-up of those patients with vascular invasion (mean, more than 5 years). The low survival rate in patients with nodal metastases (8 percent) has been noted previously, but the 87.5 percent survival rate in those patients with venous invasion without nodal involvement was considerably higher than what has been reported previously. We conclude that proper preoperative evaluation to diagnose vascular invasion will allow a carefully planned combined urologic and vascular surgical approach with removal of renal vein or vena caval tumor, while avoiding tumor thromboemboli during resection.