RADICAL NEPHRECTOMY IN PATIENTS WITH RENAL-CELL CARCINOMA WITH VENOUS, VENA-CAVAL, AND ATRIAL EXTENSION

BACKGROUND: From July 31, 1968, through August 31, 1992, 100 patients with renal cell carcinoma extending into the renal vein, vena cava, and right atrium were treated and evaluated at our institution. Each patient underwent radical nephrectomy with vena cavotomy and atriotomy as considered to be appropriate for each individual patient's tumor thrombus. METHODS: The charts were retrospectively analyzed, and surveys were sent to survivors or nearest of kin. RESULTS: The median age was 61 years, and two thirds of the tumors occurred in men (67 cases). Of the 100 patients with renal cell carcinoma resected, 13 patients (13%) had atrial extension: 75 patients (75%) had vena caval extension; and 12 patients (12%) had extension only into the renal vein. Seventy-two patients (72%) had no evidence of metastatic disease at the time of surgery and have a median survival of 21.1 years. Five-year survival is 64%, and 10-year survival is 57%. Twenty-eight patients (28%) had evidence of metastatic intraoperative and/or pathologically proven metastatic disease and have a median survival of 2.5 years with a 5-year survival of 20% and no patient living beyond 7.8 years. CONCLUSION: We believe that an extended operation for renal cell cancer with involvement of the renal vein, vena cava, and right atrium is warranted in properly selected patients and ensures reasonable long-term survival.