Pritchett T R, Lieskovsky G, Skinner D G
J Urol. 1986 Mar;135(3):460-4. doi: 10.1016/s0022-5347(17)45691-6.
Between 1972 and 1983, 25 patients were treated for renal carcinoma with tumor extension into the vena cava but without other clinical evidence of disseminated disease. Of these patients 12 had vena caval tumor thrombus extension up to the level of the hepatic veins (group 1), 10 had extension into the intrahepatic vena cava (group 2) and 3 had tumor extending into the right atrium (group 3). A perioperative management plan and an anatomical surgical approach have been developed to allow safe en bloc removal of these extensive tumor thrombi without removal of the vena cava. Successful management is dependent upon preoperative evaluation to determine precisely the extent of the disease, prophylaxis against pulmonary embolism and a well planned surgical method. For patients without evidence of metastatic or perinephric disease, the 5-year actuarial survival rate of 33 per cent is comparable to that of other patients without thrombus. Complete resection was possible in 20 patients (80 per cent), with a 5-year actuarial survival rate of 36 per cent. While patients with metastatic tumor cannot be cured, short-term palliation can be achieved for patients who have an imminent risk of vena caval occlusion or pulmonary embolism by an en bloc removal of tumor and thrombus, even for those with intra-atrial extension. Over-all, operative intervention was successful, with 22 of 25 patients leaving the hospital alive.
1972年至1983年间，25例肾癌患者接受了治疗，这些患者的肿瘤已扩展至腔静脉，但无其他播散性疾病的临床证据。其中，12例患者的腔静脉肿瘤血栓扩展至肝静脉水平（第1组），10例扩展至肝内腔静脉（第2组），3例肿瘤扩展至右心房（第3组）。现已制定了围手术期管理计划和解剖学手术方法，以便在不切除腔静脉的情况下安全地整块切除这些广泛的肿瘤血栓。成功的管理取决于术前评估以精确确定疾病范围、预防肺栓塞以及精心规划的手术方法。对于无转移或肾周疾病证据的患者，33%的5年精算生存率与其他无血栓患者相当。20例患者（80%）实现了完全切除，5年精算生存率为36%。虽然转移性肿瘤患者无法治愈，但对于有腔静脉阻塞或肺栓塞迫在眉睫风险的患者，即使是肿瘤扩展至心房内的患者，通过整块切除肿瘤和血栓也可实现短期姑息治疗。总体而言，手术干预是成功的，25例患者中有22例存活出院。
