[Diagnostic, staging and therapeutic problems in invasion of the abdominal vena cava in renal cancer].

Abstract

Between 1976 and 1987 the authors have operated 351 renal carcinomas of the clear cell type, and 51 Wilms tumours. In 35 of the patients there was malignant thrombosis of the abdominal vena cava. Total resection of the vena cava was done in the subhepatic portion in 6 of the patients, and lateral resection with removal of the thrombus was carried out in another 15 patients. In the other 14 cases thrombosis of the vena cava was accompanied by visceral, lymph node metastases, or by invasion of the surrounding organs, and palliative nephrectomy alone was done in 13 patients. One of the patients declined surgery. A new staging is suggested, of the venous invasion, which correlates satisfactorily with the patients' perspectives. Invasion of the main renal venous pathway is noted by V1, invasion of the abdominal vena cava is noted by V2 (with subgroups V2a, when the thrombus is free in the vein, without contacts with the venous wall, and V2b, when the thrombus infiltrates the wall of the vena cava. In cases staged as N0M0V2a perifascial nephrectomy and unblocking of the abdominal vena cava may achieve remarkably long survival, while the V2b substage should be assimilated to visceral metastases.