| Summary: | <p>Abstract</p> <p>Background</p> <p>The techniques for the resection of renal tumors with IVC extension are based on the experience of individual units. We attempt to provide a logical approach of the surgical strategies in a stepwise fashion.</p> <p>Methods</p> <p>Over 6-years 9 patients with renal cell carcinoma invading the IVC, underwent surgery. There were 6 males. The extension was at level IV in 4 and III in 5 cases. CPB used in 8 and hypothermia and circulatory arrest in all patients with level IV disease. The results and an algorithm of the plan of action, as per level of extension are presented.</p> <p>Results</p> <p>Plan of action: For level I-II disease: No Cardiothoracic involvement, For level III: Cardiopulmonary Bypass (CPB) & control of the cavo-atrial junction. For level IV: use of brief periods of Circulatory Arrest & repair of the Cavotomy with a pericardial patch. Postoperative morbidity: prolonged ICU stay, 3 patients (33.3%); tracheostomy, 1 (11.1%); Sepsis, 2 (22.2%); CVA 1, (11.1%). Mortality: 2 patients (22.2%)</p> <p>Conclusions</p> <p>Total clearance of the IVC from an adherent tumor is important, therefore extensive level IV disease presents a surgical challenge.</p> <p>We recommend CPB for level III and brief periods of Total Circulatory Arrest (TCA) for level IV disease.</p>
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