Tumor renal con trombo en la vena cava inferior. Manejo quirúrgico y pronóstico

ObjectivesThe aim of this study was to evaluate strategies used for surgical management of renal cell carcinoma with tumoral thrombus extension in the inferior vena cava (IVC) and evaluate patient’s prognosis.MetodsFifteen patients with renal tumor and IVC thrombus, underwent radical nephrectomy and thrombectomy, and were retrospectively evaluated. Patients were followed for 0 to 36 months (mean of 9.5 months). Computed tomography (CT) scan with three-dimensional reconstruction was used to define IVC thrombus level.ResultsThe mean age was 54 years, range from 16 to 79. The thrombus was classified as level I - 13.5%, level II – 40%, level III – 26.5% and level IV – 20%. Surgery was performed with cardiopulmonary bypass (CPB) in six (40%) cases, three (50%) without sternotomy. There was one (13%) death during the intraoperative period; this patient presented extensive metastatic tumor, with the thrombus reaching the right atrium. Patients with lymph node or metastatic disease at initial presentation had poorer overall survival in Kaplan-Meier curve. Both, tumor stage (p = 0.380), and thrombus extension (p = 0.174) were not related to survival.ConclusionsDespite its morbidity and mortality, radical nephrectomy with thrombectomy should be performed in case of renal cell carcinoma with tumoral thrombus, because it can offers the possibility of local control. Patients with lymph node and distant metastatic disease have poor prognoses.