Surgical management of renal cell carcinoma with vena cava tumor thrombus.

The results of the surgical management of 28 patients with renal cell carcinoma extending into the inferior vena cava have been analyzed. 8 patients had caval tumor thrombus extension at the level of the renal veins, 14 had infrahepatic, 5 retrohepatic and 1 atrial tumor thrombus extension. The caval wall was infiltrated by tumor in 7 cases. 9 patients had metastases. Lymph node involvement was seen in 9 patients. Life-table analysis of all 28 patients revealed on overall probability of survival of 32 and 9% at 2 and 5 years, respectively. The patients with caval involvement alone (N0M0) had a 2-year survival rate of 69%. Those with distant metastases or caval infiltration had a 2-year survival of 27 and 0% (p = NS). The level of caval tumor thrombus extension had a statistically insignificant influence on the survival of patients. In fact the 2-year survival rates of patients with caval thrombus at the level of the renal veins, below the large hepatic veins and above the large hepatic veins were 30, 36 and 32%, respectively. Our statistical data demonstrate that caval involvement has a very negative impact on the prognosis of patients with renal cancer.