Surgical Therapy of Renal Cell Carcinoma Extending into the Inferior Vena Cava

Hong, Ji Hyun; Cho, Yong Hyun; Yoon, Moon Soo

Abstract

From Oct. 1983 to Sep. 1993, 13 patients with renal cell carcinoma extending into the inferior vena cava without distant metastasis at the time of diagnosis were operated at St. Mary's hospital. The age, sex, tumor site, presenting symptoms, complications related to the operation, pathologic findings and subsequent clinical course of each patient were evaluated and analyzed. Age of patients ranged from 20 to 82 years, with an average of 57 years. Tumors occurred in male in 9 cases(69% ) and tumors occurred in the right kidney in 8 cases(62%). Initial symptoms were hematuria in 8 cases( 62% ), flank pain in 3 cases( 23%), palpable abdominal mass in 1 case(8% ) and hematuria with ascites and peripheral edema in 1 case(8%). There were two intraoperative deaths( 15%) owing to massive hemorrhage and pulmonary embolism, respectively. Postoperative complications occurred in 5 patients, including transient atelectasis in 3 patients( 23% ) and wound infection in 2 patients(15%). The pathologic findings in the 13 patients with renal cell carcinoma showed tumor confined to the kidney and inferior vena cava in 9, perinephric fat invasion in 3 and regional node involvement in 1 patient. Except 2 intraoperative deaths, 8 of the 11 patients are still alive and free of disease for 3 to 109 months (average 27months), 1 patient died after 27 months with no evidence of the disease and 2 patients died after 16 and 27 months due to distant metastasis Although intraoperative mortality is relatively high, we believe that surgical extirpation of renal cell carcinoma with inferior vena cava involvement is the treatment of choice in thesecases because of no effective alternatives.