Tumorous thrombosis of the vena cava inferior--experience with surgical treatment.

Abstract

Patients suffering from renal carcinoma, treated at the Department of Urology in Hradec Králové, have been systematically followed up since 1962. In the present study we evaluated a group of patients treated from the year 1985 till 1991. The group consisted of 365 patients with renal carcinoma. In 55 (15%) of them invasion into the renal vein or into the vena cava inferior was found (in 43 men and 12 women). In 38 patients the tumour with thrombus in the vena cava inferior was on the right side, in 17 the tumour of the left kidney was removed. The proportion of the right side to the left was 2.2:1. The surgical treatment of tumorous thrombosis depends on the upper border line of the tumorous thrombus. The tumorous thrombus in the subhepatic segment of the vena cava inferior can be treated by its massaging into the renal vein after the obliteration of the artery or by the parietal resection of the vena cava inferior. The resection of the vena cava inferior was performed in 32 patients. In 5 patients the tumorous invasion could not be treated because of extensive metastases (into the liver and the lung) or there was a tumorous parietal infiltration of the vena cava inferior. Evaluating the whole group after 30 years inclusive of the Navrátil's set made with our cooperation, there were 1,005 patients suffering from renal tumours, operated on at the Department of Urology in Hradec Králové. In 155 (15.4%) tumorous thrombi were surgically removed from the great veins. In 38 cases there was a demarcation of tumorous thrombi to the renal vein but in 117 the thrombus penetrated into the vena cava inferior.(ABSTRACT TRUNCATED AT 250 WORDS)