Surgical approaches to venous tumor thrombus.

The extension of tumor thrombus into the vena cava by renal cell carcinoma remains a technically challenging surgical condition. Attention to surgical detail and perioperative care can provide long-term survival in the appropriately selected patient. In reviewing our experience of 99 patients with venous tumor extension: renal vein only (n = 31), infrahepatic vena cava (n = 22), intrahepatic vena cava (n = 34), and intra-atrial extension (n = 12), we have demonstrated overall 2- and 5-year survival rates of 54% and 33%, respectively. Level of tumor thrombus appears to be correlated with overall survival. We continue to advocate an aggressive, optimistic approach for those patients with clinically confined tumors with isolated venous tumor thrombus extension.