Renal carcinoma with inferior vena cava tumour thrombus: An Australian experience.

Introduction: Renal cell carcinoma is known to extend into the IVC in 4-10% of cases.1-3 Despite the technical difficulty, cytoreductive nephrectomy has a role in palliation and may increase survival. We present a retrospective, multi-institution case series of patients undergoing radical nephrectomy and IVC thrombectomy. Material(s) and Method(s): We conducted a retrospective review of the medical records of patients undergoing a radical nephrectomy with caval thrombectomy performed by three uro-oncology units from June 1997 to June 2011. Patient demographics, thrombus extension, tumour size, length of stay, blood loss and complications were recorded. Outcome measures were based on disease progression and patient status at time of follow-up. Result(s): 29 patients were identified with 18 males and 11 females. The male mean age was 54, the female mean age was 63, and the overall mean age was 58 years. The patients were classified according to Neves score. 14 patients had Neves classification of I, 8 Neves II, 2 Neves III, and 5 Neves IV. Mean tumour size was 103.9mm (range 25-180). Mean blood loss was 1580mL (range 90-8500). Mean operative time (n=22) was 180 minutes (range 70-390). Mean LOS (n=18) was 8.8 days (range 5-22). 31% of patients had a positive surgical margin. Complication and follow-up data was limited. Complication data was available for 9 patients. There was one grade V complication, one IVb, one IIIa, six II, and one grade I complication. Followup data was available for 15 patients. Of these the mean survival time post operatively was 17.7 months (range 3-90) Conclusion(s): Despite the invasive nature of radical nephrectomy with caval thrombectomy, blood loss, LOS and complication rates are acceptable. Mean survival post surgery of 17.7 months will likely increase in the Tyrosine Kinase Inhibitor era. However, one must consider the physiological status of the patient prior to embarking on surgical intervention.