Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press63310.17650/1726-9776-2017-13-1-37-44DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиSurgical treatment of kidney cancer with extended inferior vena cava thrombosis: complications and long-term resultsХирургическое лечение рака почки с протяженными тромбами нижней полой вены: осложнения и отдаленные результатыAtduevV. A.АтдуевВ. А.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

профессор НижГМА

amoev_82@mail.ruAmoevZ. V.АмоевЗ. В.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

Зураб Владимирович Амоев

603001 Нижний Новгород, Нижневолжская набережная, 2

amoev_82@mail.ruDanilovA. A.ДаниловА. А.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

Bel’skiyV. A.БельскийВ. А.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

LedyaevD. S.ЛедяевД. С.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

RykhtikP. I.РыхтикП. И.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

SheyikhovG. I.ШейыховГ. И.
Russian Federation

2 Nizhnevolzhskaya Naberezhanya, Nizhniy Novgorod 603001

PuzanovS. A.ПузановС. А.
Russian Federation
Nizhniy Novgorod State Medical AcademyНижегородская государственная медицинская академияVolga District Medical CenterПриволжский окружной медицинский центр3003201713137441312201626012017https://oncourology.abvpress.ru/oncur/article/view/633

Objective. Analysis of factors affecting results of inferior vena cava (IVC) thrombectomy in patients with renal cell carcinoma.

Materials and methods. Nephrectomy with thrombectomy from IVC was performed in 53 patients (31 (58.5 %) males and 22 (41.5 %) females) with extended thrombosis. Patient age was 35–76 years (mean age 58.7 ± 10.1 years). In 36 (68 %) patients stage Т3b was determined (mean thrombus length 5.28 ±0.32 cm), in 17 (32 %) patients – stage Т3с (mean thrombus length – 13.00 ±0.71 cm). Postoperative complications were evaluated in accordance with the Clavien–Dindo classification. Calculations were performed using statistics software SPSS Statistics 16.

Results. No intraoperative complications were observed, mean blood loss was 714 (200–4000) ml. Use of the Cell Saver system allowed to perform reinfusion in the majority of patients. Blood transfusion of 200–500 ml was necessary in 15 patients. In 32 (60.3 %) patients no complications were observed. Grade I complications were observed in 2 (3.7 %) patients, grade II – in 15 (28.3 %) patients, IIIА grade – in 2 (3.7 %) patients, and grade IIIВ – in 1 (1.8 %) patient; there wasn’t any grade IV complications. Two (3.8 %) patients died of pulmonary artery thromboembolism. Correlation analysis has shown a high dependency of complications on thrombus size (r = 0.7) and blood loss volume (r = 0.6), and low dependency on tumor size (r = 0.44); complications weren’t affected by patients’ age (r = 0.1) or Karnofsky status (r = 0.0). Median overall survival was 48 months, 3-year survival was 57.1 %, median progression-free survival was 46 months, 3-year progression-free survival was 56.8 %; 90-day morbidity was absent. Three-year overall survival for рN0 was significantly higher than for рN1 (69 % vs. 25 %; р = 0.014). There was no difference in terms of survival between patients with supradiaphragmatic and subdiaphragmatic thrombi (р = 0.14).

Conclusion. Results of our study show that surgical treatment of patients with renal cell carcinoma and extended IVC thrombosis is effective. 

Цель исследования: анализ факторов, влияющих на результаты тромбэктомии из НПВ при почечно-клеточном раке.

Материалы и методы. Нефрэктомия с тромбэктомией из НПВ произведена 53 больным с протяженными тромбами. Мужчин было 31 (58,5%), женщин – 22 (41,5%). Возраст больных был от 35 до 76 (58,7±10,1) лет. Стадия Т3b была у 36 (68%) больных: протяженность тромба в среднем составила 5,28+0,32 см, Т3с установлен у 17 (32%) пациентов: протяженность тромба была в среднем 13+0,71 см. Послеоперационные осложнения классифицированы по Клавиен-Диндо. Расчёты произведены в компьютерной программе для статистической обработки данных «SPSS Statistics 16».

Результаты. Интраоперационных осложнений не было, кровопотеря составила в среднем 714 мл (мин. – 200 мл, макс.– 4000 мл). Использование аппарата Cell–Caver позволил у большинства больных проводить реинфузию. Гемотрансфузия потребовалась 15 больным в объеме от 250 мл – 500 мл. У 32 (60,3%) больных не было осложнений. I степени осложнений было у 2 (3,7%) пациентов, II - у 15 (28,3%), III «А» - 2 (3,7%), III«В» - у 1 (1,8%), IV степени – 0. Умерли 2 (3,8%) пациентов от ТЭЛА. При корреляционном анализе установлена высокая (r=0,7) зависимость развития осложнений от размеров тромба и от объёма кровопотери (r=0,6) и низкая - от размеров опухоли (r=0,44), не выявлено зависимости развития осложнений от возраста больных (r=0,1), статуса по шкале Карновского (r=0,0). 90 дневной летальности не было. Медиана общей выживаемости составила  48,0 месяцев,  3-хлетняя выживаемость – 57,1%, медиана выживаемости безпрогрессии - 46,0 месяцев, 3-хлетняя выживаемость безпрогрессии – 56,8%. Трехлетняя общая выживаемость оказалась достоверно выше при рN0 – 69%, чем при рN1 – 25% (р=0,014). При сравнении выживаемости больных с наддиафрагмальными и поддиафрагмальными тромбами различий не было выявлено (р=0,14).

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