Surgical management of renal cell carcinoma (RCC) with vena cava tumour thrombus

Objectives: Renal cell carcinoma (RCC) propagation into the inferior vena Cava is rare (10-25%) and is described as an extension above the hepatic veins up to the right atrium or even into the right ventricle. Venous tumour invasion is associated with several prognostic factors such as local infiltration of perinephric tissue, lymph nodes metastases, caval infiltration, and the presence of distant metastases. We reviewed our experience with surgical treatment of RCC with vena cava involvement. Methods: We analysed the Urological Genoa School results from 1970 to 1985 on 28 consecutive cases (Giuliani's series) and between 1986 and 2005 on 59 of 81 cases from three Italian urologic academic centres (Trieste, Bologna, and Genoa). Results: For 1970-1985, the overall survival rate for all patients was 30% at follow-up periods of 36-66 mo. With caval infiltration, the overall survival rate at 12 mo was 0%. For the period 1986-2005, the overall survival rate at 8 yr was about 80%. Nonsignificant differences for nodal stage and caval infiltration were observed during the two time periods. Conclusions: Our data confirm, as reported by others, that nonmetastatic RCC with extension into vena cava is potentially curable. (c) 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved.