Locally extensive renal cell carcinoma--current surgical management of invasion of vena cava, liver, or bowel.

Review of a personal and combined experience in cases of renal cell carcinoma invading the vena cava, liver, or bowel, has been carried out. The methodology in each of these situations is described. The long term results for survival after vena cava invasion are less than 20% at 5 years--lower than previous optimistic estimates. The long term survival with invasion of the liver or bowel is negligible. However, excellent palliation is achieved and the urological surgeon should be prepared to carry out the additional resection of adjacent invaded liver or bowel to achieve palliative nephrectomy in such cases when the invasion is found at the operating table.