Diagnosis And Treatment Of Renal Tumor Involving Inferior Vena Cava

Purpose: To evaluate the diagnosis,treatment and prognosis of renal tumor with tumor thrombus in the inferior vena cava.Methods: From February of 1993 to December of 2008, The data of 28 patiens with renal tumor involving the inferior vena cava in our hospital were analyzed retrospec- tivel. Of 28 patients, 18 were male and 10 were female. Mean age was 59.3 years (range, 11–78 years). The main presenting symptoms were haematuria and flank pain. The tumor thrombus was in level I in 2 cases,level II in16,level III in 6 and level IV in 4.All patients were examined preoperatively with Chest radiograph , B-mode ultra- sonography and computed tomography (CT). The tumor thrombus was found in 22 cases with B-mode ultrasonography,white tumor thrombus was found in all 28 cases with CT,retroperitoneal lymph node metastasis in 4 cases. The upper limit of the thrombus can be defined clearly in all 15 cases used magnetic resonance imaging (MRI) . There were 4 patients with distant metastasis,lung metastases in1,brain metastases in 1 , bone metastases in 2 cases.Results: In 20 cases undergoing operation, there were pathologically diagnosed renal clear cell carcinoma 16 cases, papillary renal cell carcinoma 1case , renal angi- omyolipoma 2 cases, Wilm's tumor 1 case.All of the 17 paitents whose tumor pathology were renal cell carcinoma, received postoperative interferon immuno- therapy. Patients were followed up 3 to 108 months (mean follow-up of 17 months).Ten patients had tumor-free survival at the last follow-up.Two patients whose tumor pathology were renal angiomyolipoma were followed up 60 months and 8 months individully.Both of them had tumor-free survival. Chemotherapy involving vincristine , pirarubicin and dactinomycin have been conducted for the child patient with Wilm's tumor after operation. The child patient was followed up 2 months ,and was tumor-free at the last follow-up.Of the 8 patients who refused operation ,3 patients were treated with renal arterial chemoembolization and interferon,1 patient was treated with radiotherapy and interferon, survived for 8-14 months, median survival time was 10.5 months .Four patients who refused any therapy,3 of them were died of systemic failure separately at 2 months,3 month and 6 months,1 of them was died of lung metastase and respiratory failure with a survival period of 20 months.Conclusions: 1. B-mode ultrasonography,CT and MRI are the main methods of the diagnosis of renal tumor with tumor thrombus in the inferior vena cava . Especially the CT and MRI have a high diagnostic value.MRI is superior to CT in location of the limit of the thrombus.2.Aggressive surgical strategy is recommended for the patient without lymph node involvement and distant metastases.3.Renal angiomyolipoma can also involve inferior vena cava. The formation of tumor thrombus is result of the tumor growth along the blood vessel wall to the inferior vena cava and its prognosis is good.