Intraoperative and oncological results of treating patients with renal cell carcinoma and venous tumor thrombus

Background. The general characteristic of renal cell cancer is metastatic invasion of tumor thrombus in the inferior vena cava (IVC). Objective is the evaluation of the results of surgical treatment of patients with renal cell carcinoma and venous tumor thrombus.

Materials and methods. During the period from 2011 to April 2017  in the Clinic of Urology at the N.I. Pirogov City Clinical Hospital No. 1 26  radical/cytoreductive nephrectomies with thrombectomy were conducted. Men predominated (n = 20 (76.9 %)) over women (n = 6 (23.1 %)) among the patients. Median age – 64 years (47–82 years). 14 (53.8 %) patients were diagnosed with disease of the right kidney and 12 (46.2 %) of the left kidney. Level I (n = 12 (46.2 %)) – renal vein, perirenal part of the IVC. Level II (n = 8 (30.8 %)) – infrahepatic part of the IVC. Level III (n = 5 (19.2 %)) – retrohepatic part of the IVC. Level IV (n = 1 (3.8 %)) – supradiaphragmatic (intrapericardial, intra-atrial) part of the IVC. Enlarged retroperitoneal lymph nodes were detected in 11 (42.3 %) cases based on the data received from computed tomography scan. 6 (23.1 %) patients were diagnosed with distant metastases at the time of operation: solitary in 4 (15.4 %) cases, multiple in 2 (7.7 %) cases.

Results. All interventions ocurred without intraoperative lethality. Median operative time – 212 minutes (140–335 minutes). Blood loss median 300 ml (50–5000 ml). Blood salvage (Cell-Saver) was used on 4 (15.4 %) patients due to major blood loss. In 4 (15.4 %) cases one of single-plane operations was performed (cholecystectomy, atypical hepatic resection, prosthetic repair of abdominal region of aorta, resection of the IV liver segment, left hemicolectomy (T4, malignant invasion in descending colon)). Postoperative complications were registered  in 8 (30.8 %) cases. Lethality in the early (30 days) postoperative period equaled 7.7 % (n = 2).

Conclusion. Radical/cytoreductive nephrectomies with thrombectomy from the IVC is a technically complex surgery. It should be performed in expert centers with material and technical resources for such operations.

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