Renal Cell Carcinoma with Vena Caval Thrombus Extending into the Right Atrium: Our Experience

Background and Aims: The incidence of inferior vena cava tumor thrombus is 4 - 10% in patients withrenal cell carcinoma (RCC). Tumor thrombus may extend into the right atrium. Survival of patients with level IV tumor thrombus is believed to be poorer. Aim of the present study was to assess short term and long term survival in patients with level IV thrombus.

Methods: From July 1996 to March 2009, 7 patients underwent surgical treatment for localized RCC and inferior vena caval thrombus extending into the right atrium. All these patients underwent radical nephrectomy with inferior vena caval thrombectomy using cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest. Pathological investigations revealed no renal capsular penetration of RCC in 4 patients and perinephric fat involvement in 3.

Results: The mean operating time was 365 min (295-390), anaesthesia time was 395 min (335-440), cardiopulmonary bypass time was 128 min (38-200) and hypothermic circulatory arrest time was 28 min (14-38). The mean follow-up time was 38 months. Presence of capsular infiltration or positive lymph nodes significantly affected survival of patients in our study with no patient having a two year survival as opposed to 100% in patients with no capsular infiltration.

Conclusions: Long term survival following the surgical treatment is probable in individuals with localized RCC extending into the right atrium. Performance of complete radical nephrectomy along with vena caval thrombectomy under circulatory arrest is a safe procedure without significant morbidity. The management is evolving for this complex group of patients. A multidisciplinary approach is associated with good short and long term results.