Objectives: Renal adenocarcinoma is characterized by marked venotropism; 20-49% show extension into the main renal vein and 4-19% into the vena cava. The present study analyzes the different diagnostic methods to evaluate the vascular involvement by renal carcinoma and presents the results achieved by total segmental cavectomy with ligation of the left renal vein and without vena caval reanastomosis.
Methods: Three patients (two males, one female) underwent total segmental cavectomy with ligation of the left renal vein in our Service over the last 10 years. A bilateral subcostal approach with access to the large vessels was utilized in all three cases. The superior and inferior renal vena cava were exposed and the hepatic veins were ligated at the level of the intrahepatic segment. Incision of the vena cava was performed, the thrombus was removed and the renal vessels were ligated. The proximal and distal segments of the vena cava were ligated after cavectomy. In the third patient, intrahepatic extension of the thrombus required the use of a temporary filter for the proximal segment of the vena cava.
Results: The early postoperative course was satisfactory; adequate renal function was maintained and no problems with venous return were observed. Of the diagnostic methods analyzed, MRI was found to be the most useful. A relationship was found between survival and the pathological stage and the presence or absence of lymph node metastasis.
Conclusions: Total segmental cavectomy without reanastomosis and with ligation of the left renal vein appears to be a feasible technique which achieves good results. MRI is the diagnostic method of choice in the evaluation of vascular tumor extension.