Management of renal tumors involving the inferior vena cava

Renal tumors account for 6% of all adult malignancies. Not uncommonly, patients with renal tumors present with tumor thrombus extending into the inferior vena cava (IVC). Vascular surgical expertise is required for optimal treatment of patients with renal tumors and caval involvement. Because tumor thrombus extending into the IVC does not predict distant metastatic disease, these patients are curable with aggressive surgical resection. Appropriate imaging studies are required preoperatively to optimally plan an operative approach best suited for complete caval tumor removal. Several operative approaches and techniques have been described for resection of these tumors depending on the extent of the caval tumor. In the absence of metastatic disease, long-term survival is most dependent on complete tumor resection. Because chemotherapy and radiation are not curative, renal tumors extending into the cava must be completely resected whenever possible.