[HSF] Renal cell ca

[erdinç naseri]

Intracaval extension of infradiaphragmatic tumors and most commonly renal cell carcinoma is classified according to the level of the extension:
Level I.within IVC and <2 cm from renal veins
        II.>2 cm but below hepatic veins
        III.above hepatic veins but below atriocaval junction
        IV.Above diaphragm
For level I and II intra-abdominal approach is enough.
For level III intra- abdominal approach by someone experienced in retrohepatic cava.
For level IV excision with CPB . Venous cannulation through femoral vein and SVC.
There is a risk of tumor/thrombus embolization in all levels (highest in level IV). 
I operated on 2 patients with level IV extension on normothermic beating CPB with PA clamping prior to opening the RA.
erdinc