VENOSE TUMORINVASION BEIM NIERENZELLKARZINOM. OPERATIVE TECHNIK, KOMPLIKATIONEN UND UBERLEBENSRATE

Renal cell carcinoma invades the vena cava in 4-10% of cases. Another 10% of patients present with invasion of the renal vein. The surgical approach, complications and long-term outcome of 95 patients were investigated. Intraoperative complications occurred in 1 of 73 patients with involvement of the renal vein and 5 of 22 patients with vena cava thrombus. One patient in each group died due to pulmonary emboli in the perioperative period. Minor renal insufficiency occurred in 39 (54.2%) and 11 (50%) of the patients respectively. The rates of minor complications such as wound infections, haematoma and pneumonia were similar in the two groups. The mean intra-operative blood loss of 780 ml in patients undergoing tumour nephrectomy was significantly lower than the blood loss of 1485 ml in patients with tumour thrombus ex tension into the vena cava. The 5-year survival rate of patients with V1 tumours (71%) is comparable to that of patients without venous involvement. Tumour extension into the vena cava (V2) influences the 5-year survival rate significantly, decreasing it to 56.7%. In conclusion, long-term survival can be achieved for patients with renal cell carcinoma and venous involvement, though for patients with lymph node metastases or distant metastases only short-term palliation can be achieved. However, the potential benefits should be carefully weighed against the possible complications, the surgical morbidity and the resources expended in vena cava resection.