To investigate the outcome of surgical treatment for patients with left renal carcinoma associated with inferior vena cava(IVC) tumor thrombus.

Data from 25 consecutive patients (15 male cases and 10 female cases) with left renal carcinoma and IVC thrombus were retrospectively reviewed in our hospital from December 2009 to December 2014.The patients were classified according to location of the upper extent of the tumor thrombus, including level Ⅰ (or renal) in 9 cases(36%), level Ⅱ (or retrohepatic) in 9 cases (36%), level Ⅲ (or suprahepatic) in 4 cases(16%) and level Ⅳ (or atrial) in 3 cases (12%). Magnetic resonance angiography was applied in each patient to determine the accurate location of tumorous embolus.All patients accepted radical nephrectomy and caval thrombectomy under the general anesthesia.For cases with the level Ⅰand Ⅱ thrombus (the sub–hepatic thrombus type), caval thrombectomy was not performed until the bilateral renal veins and sub–hepatic IVC were well–exposed and controlled by tourniquets.For cases with level Ⅲ thrombus (the post–hepatic thrombus type), sub–thrombus IVC, bilateral renal veins, first hilus hepatis and retrohepatic IVC should be exposed and controlled sequentially through piggyback technique assisted by specialist before caval thrombectomy.For the cases with level Ⅳ thrombus (the supra–diaphragm type), the thrombectomy was performed under control of superior vena cava through thoracotomy if embolus was found near the right atrium.Otherwise, extracorporeal circulation should be considered.

All patients received radical nephrectomy and caval thrombectomy successfully with the lesions extirpated.No death occurred during hospital stay.The average operation duration was 180 min(range 130–300 min)and blood loss was 500 ml(range 200–3 000 ml). One patient (level Ⅲ tumor thrombus) complicated by pulmonary embolism and rescued via thrombectomy by the cardiovascular specialists under extracorporeal circulation.The mean duration of follow–up was 47 months, ranged from 3 months to 60 months.The disease–free survival rate was 52% (13 cases) and the survival with tumor rate was 12% (3 cases). The rest 9 patients (36%) died due to liver or lung metastasis and multiple organ failure.The 5–year survival rate in the individual level were as follows: level Ⅰin 8 cases(50%), level Ⅱ in 6 cases (38%) and level Ⅲ in 2 cases (13%).

Radical nephrectomy and caval thrombectomy is a viable and definitive treatment for left renal carcinoma associated with tumor embolus in the IVC.Extracorporeal circulation and atriotomy should be considered in the cases of acute pulmonary embolism caused by tumor thrombus.

Renal carcinoma; Tumor embolus in inferior vena cava; Surgical treatment