Surgical treatment of Renal Cell Carcinoma (RCC) with level III–IV tumor venous thrombosis

M. I. Davydov; Давыдов М. И.; V. B. Matveev; Матвеев В. Б.; M. I. Volkova; Волкова М. И.; P. I. Feoktistov; Феоктистов П. И.; K. P. Kuznetsov; Кузнецов К. П.; I. V. Nekhaev; Нехаев И. В.; S. V. Lomidze; Ломидзе С. В.; O. V. Zhuzhginova; Жужгинова О. В.; K. M. Figurin; Фигурин К. М.; V. A. Chernyaev; Черняев В. А.; E. V. Ogorodnikova; Огородникова Е. В.

doi:10.17650/1726-9776-2016-12-4-21-34

Surgical treatment of Renal Cell Carcinoma (RCC) with level III–IV tumor venous thrombosis

Authors: Davydov M.I.¹, Matveev V.B.¹, Volkova M.I.¹, Feoktistov P.I.¹, Kuznetsov K.P.¹, Nekhaev I.V.¹, Lomidze S.V.¹, Zhuzhginova O.V.¹, Figurin K.M.¹, Chernyaev V.A.¹, Ogorodnikova E.V.¹
Affiliations:
1. N.N. Blokhin Russian Cancer Reseach Center, Ministry of Health of Russia
Issue: Vol 12, No 4 (2016)
Pages: 21-34
Section: DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCER
Published: 30.12.2016
URL: https://oncourology.abvpress.ru/oncur/article/view/622
DOI: https://doi.org/10.17650/1726-9776-2016-12-4-21-34
ID: 622

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Objective: to assess the results of nephrectomy, thrombectomy in RCC patients with level III–IV tumor venous thrombosis with and without cardiopulmonary bypass.

Materials and methods. Medical data of 167 consecutive RCC patients with level III–IV tumor venous thrombosis underwent nephrectomy thrombectomy in N.N. Blokhin Russian Cancer Research Center between 1998 and 2012 were collected. Right side tumor was in 122 (73.1 %), left side – in 42 (25.1 %), bilateral – in 3 (1.8 %) cases. The extent of thrombus was defined as intrahepatic in 82 (49.1 %), supradiaphragmatic – in 85 (50.9 %) (intrapericardial – in 44 (26.3 %), intraatrial – in 39 (23.4 %), intraventricular – in 2 (1.2 %)) cases. Nephrectomy, thrombectomy with cardiopulmonary bypass was used in 9 (5.4 %), 158 (94.6 %) patients underwent radical nephrectomy with thrombectomy without CPBP and sternotomy. Intrapericardial IVC and right atrium were exposed through transdiaphragmatic approach and providing vascular control over infradiaphragmatic IVC and renal veins.

Results. Median blood loss was 6000 (600–27 000) ml. Complications rate was 62.8 %, 90-day mortality – 13.2 %. Intraoperative complications were registered in 80 (47.9 %), postoperative – in 66 (40.5 %) (grade II – 16 (9.8 %), grade IIIb – 1 (0.6 %), grade IVа – 28 (17.2 %), grade IVb – 3 (1.8 %), grade V – 18 (11.1 %)) patients. Modified thrombectomy technique insignificantly decreased blood loss compared to thrombectomy with CPB, did nоt increase complications rate including pulmonary vein thromboembolism, or mortality. Five-year overall, cancer-specific and recurrence-free survival was 46.2, 58.3 and 47.1 %, respectively. Thrombectomy technique did nоt affect survival.

Conclusion. In selected patients with mobile thrombi transdiaphragmatic approach allows to avoid the use of CPBP and decrease surgical morbidity without survival compromising.

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kidney cancer, venous tumor thrombus, thrombectomy

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Surgical treatment of Renal Cell Carcinoma (RCC) with level III–IV tumor venous thrombosis

Full Text

Abstract

Keywords

About the authors

References

Supplementary files