The impact of extracorporal circulation on therapy-related mortality and long-term survival of patients with renal cell cancer and intracaval neoplastic extension

In approximately 4%-10% of patients presenting with renal cell cancer, the transluminal propagation of a tumour thrombus into the vena cava inferior or the right atrium comes to diagnosis. Recent investigations have indicated that the presence of neoplastic extension into the venous system does not reveal independent prognostic value regarding the clinical course of the disease. Although the complete surgical removal of vena cava thrombosis in patients without simultaneously occurring regional lymph node or distant metastases has become a well established treatment modality, several questions concerning this surgical strategy still remain the subject of ongoing discussions. In the present investigation that included 92 patients with renal cell cancer and intracaval neoplastic extension, it was clearly demonstrated that using cardiopulmonary bypass, deep hypothermia and circulatory arrest - preferably, during the removal of intracaval thrombosis extending into the right atrium - does not result in a substantially increased treatment-related intra- or postoperative mortality. However, in contrast to a previously reported observation, this treatment option did not reveal any substantial impact on the long-term survival of the patients following surgical therapy. Accordingly, the cranial extension of intracaval thrombosis was not identified as a biological variable of any prognostic importance for renal cell cancer patients.