Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press64410.17650/1726-9776-2017-13-1-27-36DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. RENAL CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак почкиSurgical treatment of renal cell carcinoma with advanced tumor invasion of the inferior vena cavaХирургическое лечение больных раком почки с массивной опухолевой инвазией нижней полой веныDavydovM. I.ДавыдовМ. И.
Russian Federation

Директор ФГБУ "РОНЦ им.Н.Н.Блохина", академик РАН,

mivolkova6@gmail.comMatveevV. B.МатвеевВ. Б.
Russian Federation

Зав.отделением урологическим, профессор

vsevolodmatveev@mail.ruVolkovaM. I.ВолковаМ. И.
Russian Federation

24 Kashirskoe Shosse, Moscow 115478

Мария Игоревна Волкова

mivolkova6@gmail.comBegalievA. K.БегалиевА. К.
Russian Federation
mivolkova6@gmail.comFeoktistovP. I.ФеоктистовП. И.
Russian Federation
mivolkova6@gmail.comKuznetsovK. P.КузнецовК. П.
Russian Federation
mivolkova6@gmail.comNekhaevI. V.НехаевИ. В.
Russian Federation
mivolkova6@gmail.comLomidzeS. V.ЛомидзеС. В.
Russian Federation
mivolkova6@gmail.comZhuzhginovaO. V.ЖужгиноваО. В.
Russian Federation
mivolkova6@gmail.comOgorodnikovaE. V.ОгородниковаЕ. В.
Russian Federation
mivolkova6@gmail.comAbgaryanM. G.АбгарянМ. Г.
Russian Federation
mivolkova6@gmail.comChernyaevV. A.ЧерняевВ. А.
Russian Federation
mivolkova6@gmail.comKlimovA. V.КлимовА. В.
Russian Federation
mivolkova6@gmail.comN.N. Blokhin Russian Cancer Reseach CenterРоссийский онкологический научный центр им. Н.Н. Блохина3003201713127362912201614022017https://oncourology.abvpress.ru/oncur/article/view/644

Objective. To evaluate short-term and long-term results of nephrectomy, thrombectomy, circular inferior vena cava (IVC) resection in patients with renal cell carcinoma (RCC) and advanced IVC tumor invasion.

Materials and methods. Medical data of 49 patients with RCC and level II–IV tumor venous thrombus with advanced IVC wall tumor invasion were analyzed. All the patients underwent nephrectomy, thrombectomy, circular IVC resection (radical – 35 (71.0 %), cytoreductive, in M+ cases – 14 (28.6 %)). Circular resection of the infrarenal IVC segment was performed in 25 (51.0 %) patients; resection of the infrarenal, perirenal and retrohepatic IVC segments with a ligation of the left renal vein (RV) – in 24 (49.0 %) patients. Perirenal IVC prosthesis was used in 2 (4.1 %) patients with initially preserved IVC blood flow, in other cases replacement of the removed IVC segment wasn’t performed due to presence of a network of venous collaterals duplicating the IVC. Patients with metastases received systemic antitumor treatment after nephrectomy, thrombectomy.

Results. Median operative time was 260 (135–580) minutes, median blood loss was 8750 (3000–27 000) ml. Severe intraoperative complications were observed in 2 (4.0 %) patients, 1 (2.0 %) patient died on the operating table due to hypovolemic shock. Postoperative complications were observed in 26 (53.2 %) cases (grade III–V in 22 (45.8 %) patients). Five-year overall and cancer-specific survival of all patients was 54.6 and 67.8 %, respectively, relapse-free survival of 35 patients with M0 category was 49.4 %. Both IVC prostheses were patent 12 months after the surgery. Function of the left kidney after ligation of the left RV was preserved at the preoperative level in all 24 patients in a median of 12 (2–120) months.

Conclusion. Nephrectomy, segmental/subtotal cavectomy with preservation of the main renal venous entries is an effective treatment method in RCC patients with advanced tumor IVC invasion. The method allows to achieve satisfactory long-term survival rates and functional results. 

Цель работы – оценка непосредственных и отдаленных результатов нефрэктомии, тромбэктомии, циркулярной резекции нижней полой вены (НПВ) у больных раком почки с массивной инвазией НПВ.

Материалы и методы. Проанализированы данные 49 больных раком почки с опухолевым венозным тромбозом II–IV уровней, инфильтрирующим стенку НПВ на большом протяжении, подвергнутых нефрэктомии, тромбэктомии, циркулярной резекции НПВ (радикальной – 35 (71,0 %), паллиативной при наличии отдаленных метастазов – 14 (28,6 %)). Циркулярная резекция инфраренального сегмента НПВ произведена 25 (51,0 %), инфраренального, периренального и ретропеченочного сегментов НПВ с перевязкой левой почечной вены – 24 (49,0 %) пациентам. Двум (4,1 %) больным с исходно сохраненным кровотоком по НПВ выполнено протезирование периренального отдела НПВ, в остальных случаях замещение удаленного сегмента НПВ не выполнялось в связи с наличием сети венозных коллатералей, дублирующих НПВ. Пациенты с метастазами рака почки после паллиативной нефрэктомии, тромбэктомии получали системное противоопухолевое лечение.

Результаты. Медиана операционного времени – 260 (135–580) мин, медиана кровопотери – 8750 (3000–27 000) мл. Серьезные интраоперационные осложнения развились у 2 (4,0 %) больных, 1 (2,0 %) пациент умер на операционном столе от геморрагического шока. Послеоперационные осложнения зарегистрированы в 26 (53,2 %) случаях (III–V степеней тяжести – 22 (45,8 %)). Пятилетняя общая и специфическая выживаемость всех больных составила 54,6 и 67,8 % соответственно, безрецидивная выживаемость 35 радикально оперированных пациентов – 49,4 %. Оба протеза НПВ через 12 мес после операции проходимы. Функция левой почки после перевязки левой почечной вены при медиане наблюдения 12 (2–120) мес сохранилась на дооперационном уровне у всех 24 больных.

Заключение. Нефрэктомия, сегментарная/субтотальная кавэктомия с сохранением устьев главных печеночных вен – эффективный метод лечения больных раком почки с массивной опухолевой инвазией НПВ, позволяющий добиться удовлетворительных показателей отдаленной выживаемости и хороших функциональных результатов. 

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