Early postoperative complications of renal cell cancer surgery with inferior vena cava tumor thrombus invasion

Abstract

Objective To analyze the early postoperative complications in renal cell cancer (RCC) surgery with inferior vena cava tumor thrombus(IVCTT) invasion. Methods The clinical data of 27 patients with RCC and IVCTT from February 2015 to April 2016 were analyzed retrospectively. Of the 27 patients, 21 were male and 6 were female. The average age was (61.7±9.8) years old (47 to 84 years). The average body mass index (BMI) was (22.2±2.9) kg/m2 (17.6 to 30.8 kg/m2). Imaging suggested the right renal tumor in 18 cases and left renal tumor in 9 cases. The tumor size ranged from 3.6 to 21.1 cm.The renal vein tumor thrombus or inferior vena cava tumor thrombus was found in all patients, including type 0 thrombus in 6 cases, typeⅠ thrombus in 6 cases, type Ⅱ thrombus in 8 cases, type Ⅲ thrombus in 5 cases and type Ⅳ thrombus in 2 cases (Mayo Medical Center classification). We completed laparoscopic surgery for RCC with IVCTT in 14 cases and open surgery in 13 cases. Postoperative complications were graded according to the modified Clavien classifications, respectively. Serious complications were defined as grade Ⅲ or higher. Results Among 27 patients, early postoperative complications occurred in 14 cases (51.9%). Chyle leak occurred in 2 cases, they were cured after treated with diet control and subcutaneous injection of somatostatin. Lower extremity venous thrombosis occurred in 3 cases, they were cured after treatment with low molecular weight heparin. Three cases had postoperative pulmonary infection and were cured after antibiotics treatment. Bilateral thigh rash occurred in 1 case. Considering related with antibiotic induced allergy, we stopped the drug and treated with intravenous drip of vitamin C and glucose acid calcium. Serious postoperative complication rate was 18.5% (5 cases). One case had postoperative abdominal distension and peritoneal effusion. He underwent ultrasound guided puncture and drainage. Renal insufficiency and hyperkalemia occurred in 2 cases, they were cured after treatment with hemodialysis. One case died of postoperative blood pressure decrease and cardiac arrest. One case died of postoperative hypoxemia, septic shock, multiple organ dysfunction. Conclusions Postoperative complications or serious complications may occur after surgery for RCC with IVCTT. Understanding the causes and characteristics of complications, prevention and early treatment are key measures to reduce the incidence rates. Key words: Postoperative complications; Carcinoma, renal cell; Tumor thrombus; Vena cava, inferior