Renal Cell Carcinoma with Vena Caval Extension: Operative Management

Abstract

Renal cell carcinoma, unless it is localized, remains a difficult tumor to cure. There were nearly 23000 new cases of renal cell cancer diagnosed in the United States alone in 1989, and there were almost 10000 deaths directly related to this disease. For the majority of patients, radical nephrectomy with early ligation of the renal artery and vein and regional lymph node dissection remains the primary therapy for potentially curable disease. The natural history of this tumor is quite unpredictable except for patients presenting with metastatic disease for whom 5-year cures are rarely achieved. The best cure rate is seen in patients with cancer confined to the kidney and 5-year survivals may approach 70%. Once the tumor invades the perinephric fat the 5-year survival drops to 50%. Regional lymph node involvement which occurs in approximately 20% of patients at the time of diagnosis further decreases survival, and spread to contiguous viscera or distant metastases results in only an occasional cure without effective adjuvant therapy.