Burt J D, Bowsher W G, Joyce G, Peters J S, Wood A, White A, Costello A
Department of Urology, St. Vincent's Hospital, Melbourne, Victoria, Australia.
Aust N Z J Surg. 1993 Jan;63(1):25-9. doi: 10.1111/j.1445-2197.1993.tb00028.x.
Seven patients with renal cell carcinoma involving the inferior vena cava underwent surgical resection between 1975 and 1991. Pre-operative staging defined five patients with stage T3bNoMo disease, one patient with stage T3bN1Mo, and one patient with stage T3bNoM1 disease. At operation one patient had tumour thrombus filling the right atrium. Two patients had tumour thrombus within the intrahepatic vena cava and four infrahepatic tumour thrombus. The mean follow-up is 34.4 months (median 40 months). Four patients have been followed for over 4 years. Three of these patients are survivors, two have remained disease-free since their initial surgery. The other patient had a liver resection at 49 months for a solitary metastases; he is currently disease free. One patient died at 38 months from a gastrointestinal haemorrhage. Three patients are 12 months or less postoperation. Operative mortality was zero. The mean postoperative hospital stay was 14.7 days. Data suggests that 3-10% of renal cell carcinomas will involve the inferior vena cava. The small number of patients in this series suggests that many patients with renal cell carcinoma involving the inferior vena cava are not referred for surgical assessment. These patients are potential surgical candidates. Their survival after surgical resection, excluding the group with extension of tumour thrombus into the hepatic cava or above, is not reduced when compared with other patients with renal carcinoma.
1975年至1991年间，7例累及下腔静脉的肾细胞癌患者接受了手术切除。术前分期显示，5例患者为T3bNoMo期疾病，1例为T3bN1Mo期，1例为T3bNoM1期疾病。手术时，1例患者的肿瘤血栓充满右心房。2例患者的肝内静脉有肿瘤血栓，4例患者有肝下肿瘤血栓。平均随访时间为34.4个月（中位数为40个月）。4例患者已随访超过4年。其中3例患者存活，2例自初次手术后一直无病生存。另1例患者在49个月时因孤立性转移接受了肝切除术；他目前无病生存。1例患者在38个月时死于胃肠道出血。3例患者术后12个月或更短时间。手术死亡率为零。术后平均住院时间为14.7天。数据表明，3%至10%的肾细胞癌会累及下腔静脉。本系列患者数量较少，表明许多累及下腔静脉的肾细胞癌患者未接受手术评估。这些患者是潜在的手术候选者。与其他肾癌患者相比，他们手术切除后的生存率（不包括肿瘤血栓延伸至肝静脉或更高部位的患者）并未降低。
