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[Diagnostic and therapeutic approach to the extension of kidney cancer to the vena cava].

In the light of their experience with 16 cases seen over 5 years, the authors analyze the diagnostic and therapeutic tools for assessment of the vena cava thrombi that complicate 5 to 10% of renal carcinomas. Cavography still plays a central part in the detection of vena cava lesions. Localization of the upper extremity of the thrombus is needed to decide upon the operative technique and can be achieved by free flow inferior cavography for free floating thrombi; for complete thrombi, the two most informative procedures appear to be echocardiography (to evaluate the right atrium and intrathoracic inferior vena cava) and inferior cavography by the superior route; it seems that computed tomography provides no additional information in the assessment of extensive spread to the inferior vena cava. 14 patients were treated surgically: the surgical approach is dictated by the location of the thrombus and should allow control of the vena cava proximal to the thrombi. Two patients with a thrombus that extended into the right atrium had surgery using extracorporeal circulation; because this method is especially safe, extension of its indications to retrohepatic thrombi may be justified. The absence of operative mortality and comparison of results to those previously reported in the literature confirm the value of surgical treatment of vena cava lesions, especially if there is no lymph node involvement.