Renal Cancer pp 251-269 | Cite as

Surgery for Renal Cell Carcinoma with Thrombus Extension into the Vena Cava



The incidence of renal cell carcinoma continues to rise secondary to increased imaging utilization with the majority of new cases being lower stages based on size criteria. The incidence of larger renal tumors with known propensities for venous thrombus formation is still present and remains a challenge for the urological community in terms of surgical treatment with acceptable oncological outcomes and limited complications. Proper staging and preoperative imaging are crucial to determine the best approach with limited morbidity.

As previously described by multiple authors and institutions, the level of tumor thrombus is one if not the most important factor in determining the surgical approach. We detail our approach model and surgical technique in great detail with respect to thrombus within the renal vein, extending into the inferior vena cava and extending into the right atrium.

This chapter also provides data and technical descriptions from our contemporaries at other institutions describing alternative approaches. This latter section can be of utmost importance during any surgical procedures in which unanticipated complications can arise. We have also included our own personal experience with this patient population which is one of the largest within the urological community.


Renal Cell Carcinoma Cardiopulmonary Bypass Renal Vein Radical Nephrectomy Tumor Thrombus 
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© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of UrologyLahey ClinicBurlingtonUSA
  2. 2.Institute of Urology, Lahey ClinicBurlingtonUSA

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