Surgical treatment of renal cell carcinoma with extension into the vena cava

✍ Scribed by G. D. Steinberg; B. A. Reitz; F. F. Marshall

• Publisher: Springer-Verlag
• Year: 1991
• Tongue: English
• Weight: 717 KB
• Volume: 9
• Category: Article
• ISSN: 0724-4983
• DOI: 10.1007/bf00182836

✦ Synopsis

Four to ten percent of patients with renal cell carcinoma have extension of tumor thrombus into the vena cava. These cancers remain resistant to chemotherapy or radiotherapy. Aggressive surgical therapy for these patients, with no apparent evidence of metastatic disease using hypothermia, temporary cardiac arrest and exsanguination with cardiopulmonary bypass, has been demonstrated to be feasible with acceptable morbidity. Unfortunately, many of these patients also have locally advanced disease and approximately 30O/o have positive lymph nodes at the times of exploration. Survival for these patients is generally unfavorable and is related to the degree of regional tumor spread. However, many who undergo surgical extirpation can return to active lives, if only for 1-2 years. There is at present no effective chemotherapy for advanced renal cell carcinoma, but experimental protocols using combinations of immunotherapy and chemotherapy with encouraging results are currently underway. In the future, these patients may greatly benefit from a combined aggressive surgical approach with reduced morbidity and adjuvant therapy. * To whom correspondence should be addressed Recently, hypothermia, temporary cardiac arrest and exsanguination with cardiopulmonary bypass, especially for tumor thrombus above the diaphragm, has been described by several investigators [6, 9, ll, 12, 22]. This technique permits careful dissection in a virtually bloodless field, with less risk of embolization [9,11]. In this article, the preoperative evaluation, intraoperative management and long-term results for patients with renal carcinoma with vena caval extension treated at the Johns Hopkins Hospital from 1981-1988 are reviewed.