Long-term followup after surgical treatment for renal cell carcinoma extending into the right atrium

Purpose: Renal cell carcinoma extends into the inferior vena cava in 4 to 10% of patients and it is believed that the cephalad extent of inferior vena caval involvement is inversely correlated with survival. We evaluated this issue further. Materials and Methods: From June 1984 to August 1993, 18 patients underwent surgical treatment for localized renal cell carcinoma and an inferior vena caval thrombus extending into the right atrium. One patient had a contralateral adrenal metastasis at operation. All patients underwent complete tumor excision with radical nephrectomy and inferior vena caval thrombectomy using adjunctive cardiopulmonary bypass and deep hypothermic circulatory arrest. Pathological study indicated no renal capsular penetration of renal cell carcinoma in 10 patients and perinephric fat involvement in 8. Results: The overall and cancer-specific 5-year survival rates were 56.6% and 60.2%, respectively. Eight patients (45%) were free of malignancy at a mean of 71.6 months. One patient was alive with metastatic disease 15 months postoperatively, There was 1 operative death, while 8 patients died of metastatic renal cell carcinoma at a mean of 18.8 months postoperatively. Mean postoperative survival was significantly improved in patients with no renal capsular penetration by tumor compared to those with perinephric fat involvement (58.1 versus 19.7 months, p = 0.035). Conclusions: Long-term survival after surgical treatment is possible in patients with localized renal cell carcinoma extending into the right atrium. In patients with localized renal cell carcinoma and an inferior vena caval tumor thrombus the cephalad extent of inferior vena caval involvement does not appear to be prognostically important.