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Surgical Management of Renal Cell Carcinoma with Vena Caval Extension

Retrohepatic vena cava surgery was performed in nine patients with renal cell carcinoma and with a propagation of the neoplastic thrombus into the inferior vena cava (IVC) up to the confluence with hepatic veins or to the right heart. Surgical treatment consisted of simultaneous radical nephrectomy and exploration of the retrohepatic vena cava with careful removal under direct vision of the thrombus, which was attached to the intima. In two patients cardiopulmonary bypass was used. All procedures were performed under IVC exclusion. Five patients are still alive from 2 up to 48 months after surgery. Surgical technique and postoperative management including vascular complications are discussed.