Discussions On The Surgical Treatment Of Renal Cell Carcinoma With Tumor Thrombus In The Inferior Vena Cava

Objective: This summary mainly discusses how to further perfect the ways of surgical treatments for renal cell carcinoma with tumor thrombus in inferior vena cava. We discuss and research different methods of operations specificed to various levels so as to conclude some experiences of the surgical treatments of them.Then we assess the diagnosis and prognosis of the condition.Methods: Retrospective studies was adopted as a method to research 35 patients who were suffered frome Renal cell carcinoma with tumor thrombus in inferior vena cava from 2006.1 to 2011.1. Of 35 patients 31 were male and 4 were female.Mean age was 55.5 years(range 42–69 years). The main presenting symptoms of 35 patients were haematuria,abdominal pain and abdominal mass. 25 cases took a hematuria as a first sign(25/35 71.42%) .6 cases took abdominal pain(6/35 17.14%) and 4 cases took abdominal mass(4/35 11.43%).All patients were examined preoperatively with Chest radiograph,B ultrasonography and computed tomography(CT). The tumor thrombus was found in 13 cases with B ultrasonography(13/35 37.14%)while 28 cases with CT. 13 cases were diagnosed by MRI(13/35 37.14%). 2 cases were diagnosed by radiography of vena cava(2/35 2.9%). For the 35 patients above tumor thrombus can be classificated into five levels according to Mayo clinic medical center. 16 cases were level 0 ; 8 cases were levelⅠ; 7 cases were levelⅡ; 4 cases were levelⅢ.According to tumor thrombus forms and we divided them into two types: Punched out type and spread prostrate type. Amonge 35 patients 32 cases were of former one. 3 cases were of later one. Radical nephrectomy with extraction of the thrombus was carried out for 31 patients And 2 patients who belong to levelⅢwere operated by radical nephrectomy,sectional venacavorectomy and ligation of left renal vein.The other two patients were operated by venovenous bypass(VVB),IVC of one case was repaired with pericardium piece.Results:All operations were successful, and no tumoral embolism happened. 1 case who's IVC was repaired with pericardium piece died in following 3 months duing to the pulmonary embolism. 2 patients who were operated by radical nephrectomy,sectional venacavorectomy,ligation of left renal vein did not have abnormal changes of renal function and edema of lower extremity.The operation time ranged from 2 hours to 6 hours. The mean occlusion time was 18 minutes(range 11 to 25 minutes).The total bleeding were 50ml to 3800 ml. All cases had been followed-up for 3 to 46 months. 4 patients died from 3 to 33 months after the operation. 29 patients who were still alive had been followed-up for 14 to 46 months and 6 cases relapsed later. Postoperative pathologic: 29 cases were of renal cell carcinoma; 5 cases were of adenocarcinoma; 1 case was of Sarcomatoid carcinoma.Conclusion:1 Surgical treatment is still a preferred treatment for renal cell carcinoma with tumor thrombus in inferior vena cava. The choice of different operations is mainly depends on tumor thrombus grading.2 Surgical excision of operation for tumor thrombus of level 0 and levelⅠis simpler and less postoperative complications are found.3 Surgical resection is used for levelⅡtumors in principle. If they had several lymph node metastasis even distant metastasis we more inclined to choose conservative treatments.4 If tumor thrombus blocked inferior vene cava,right RCC with tumor thrombus belongs to levelⅢcan be operated by radical nephrectomy, sectional venacavorectomy,ligation of left renal vein. Abnormal changes of renal function and edema of lower extremity were not found after the operation.5 The operations of tumor thrombus of levelⅢneed collaboration of multi-department. If lymph metastasis and distant metastasis were not found ,the patients should be treated by surgical operation.The resections of the tumor thrombus for the two kinds of patients are more complicated. Post-operative complications could occur.The survival rates go down compared to the three levels above .