Renal Cell Carcinoma with Vena Cava Thrombus: Diagnosis and Survival--Twenty Years Experience in a Single Institution

Objectives : To evaluate the diagnosis of presence and/or cephalad extent of an inferior vena cava (IVC) tumour thrombus and its impact on survival. Methods : We reviewed our patients with renal cell carcinoma (RCC) extending into the IVC, operated between 1977 and 1996. Diagnostics, operative morbidity and mortality were analysed. Cancer-specific survival was related to presence and cranial extent of the vena cava thrombus (VCT). Results : Forty-two patients with RCC and a VCT underwent surgical resection. Twenty of these patients with pT3b-cNoMo tumours were compared with a matched control group of 20 patients without VCT (pT2/T3aN0M0). The overall post-operative complication rate was 65%. Major complications were predominantly seen in three patients who died in the post-operative phase. The cancer specific 3- and 5-year survival was 45 and 33% for all patients with a VCT, 48 and 40% in the pT3b-cN0M0 group ( n =18) and 90 and 84% for the pT2/T3aN0M0 group ( n =20). The 3-year survival rate corrected for the cephaled extent of the thrombus was 60% for level I and II thrombi compared to 26% for level III and IV thrombi. Conclusions : CT scanning and Doppler ultrasound appear sufficiently accurate imaging techniques in determining presence and extent of a tumour thrombus into the IVC. The presence and cranial extension of a tumour thrombus into the IVC have a negative impact on the prognosis. Despite this, patients with pT3b-cN0M0 RCC still have a 5-year adjusted (cancer-specific) survival rate of 40%.