Radical nephrectomy with vena caval thrombectomy: a contemporary experience

OBJECTIVE To report on the contemporary Memorial Sloan-Kettering Cancer Center experience with radical nephrectomy and vena caval thrombectomy. PATIENTS AND METHODS Patients who underwent radical nephrectomy and vena caval thrombectomy without the use of bypass techniques were retrospectively identified. Data were collected on intraoperative and pathological findings as well as postoperative complications and oncological outcomes. RESULTS In all, 78 patients underwent radical nephrectomy with off-bypass resection of vena caval thrombus between 1989 and 2009. The median (interquartile range, IQR) operation duration was 293 (226-370) min, and median (IQR) blood loss was 1300 (750-2500) mL. In all, 10 patients (13%) were confirmed to have intra- or supra-hepatic tumour thrombus (level 3/4), eight of whom required supra-hepatic control of the inferior vena cava (IVC). Major (grade 3-5) postoperative complications occurred in 14 (18%), with five postoperative deaths. Disease recurred in 27/62 patients who were considered completely resected at surgery and had adequate follow-up. The overall 5-year survival (95% confidence interval) probability was 48% (35-60%). CONCLUSIONS Radical nephrectomy with vena caval thrombectomy is associated with acceptable postoperative morbidity and mortality, and long-term survival is possible in some patients. Many level 3/4 thrombi could be safely approached without the use of bypass techniques.