Management of renal cell carcinoma with extension into the vena cava is one of the highest challenges in urology. The delineation of the upper level of the endocaval thrombus, its possible extension into the hepatic veins and possible involvement of the cavai wall are crucial points and dictate the operative strategy. From 1978 to 1989, at the Department of Urology of the University of Padua, 29 patients with renal cell carcinoma and cavai extension were submitted to surgery. Seventeen patients were staged V(2) according to the UICC TNM Staging System 1983, 2 patients V(3) and 10 V(4). The median patient age was 57 years and the male:female ratio was 1.9:1. A complete thrombus removal was accomplished in all patients. In 2 patients, a cavai resection was necessary. Five patients died during the perioperative period. The patient survival rate was comparable to that of T(3)N(o)M(o)-staged cases. Survival rates at 1 and 4 years were, respectively, 96.8 and 40% for V(2) cases, 100 and 100% for V(3), 85.7 and 40% for V(4). It seems, therefore, that in patients with locorégional disease and satisfactory conditions, the presence of vascular invasion did not lead to a worst prognosis. By itself, the extent of the cavai thrombus seems not to influence the prognosis.

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