[Diagnosis and treatment of renal cell carcinoma with vena cava tumor thrombi].

BACKGROUND & OBJECTIVE: Renal cell carcinoma (RCC) might involve the renal vein, and form tumor thrombus extending into the vena cava or the right atrium. Treating RCC with vena cava involvement is difficult in clinical practice. Radical nephrectomy with complete tumor thrombus removal could result in good outcomes for RCC patients with vena cava thrombi. This paper was to report our experiences on treating RCC with vena cava thrombi.

METHODS

From May 1995 to Oct. 2003, radical nephrectomy plus vena cava thrombus removal was performed in 14 RCC patients. Clinical records, including preoperative diagnosis, operation pattern, and prognosis, of these 14 patients were analyzed retrospectively.

RESULTS

Vena cava thrombi were detected in 9 patients, and missed in 5 patients by ultrasonography. CT scan revealed vena cava thrombi in 12 of 14 patients. MRI has been performed in 8 patients, and clearly demonstrated extent of the thrombus. Twelve cases of tumor thrombi within infrahepatic vena cava, 1 within intrahepatic subphrenic vena cava, and 1 within supraphrenic vena cava. The patients have been followed up for 6-70 months after surgery. Thirteen patients survived with disease-free, and 1 patient (stage IIIc) died of cancer 23 months after surgery.

CONCLUSION

Vena cava thrombi in patients with RCC could be detected on CT scan and ultrasonography. MRI is more accurate than CT,and ultrasonography in delineating extent of the thrombus. Radical nephrectomy plus vena cava thrombus removal could achieve long-term survival for patients with localized RCC and vena cava thrombi.