FACTORS OF PERIOPERATIVE MORTALITY IN PATIENTS WITH GROWING RENAL CELL CARCINOMA IN INFERIOR VENA CAVA LUMEN

Abstract

Difficult surgical cases of tumors of the inferior vena cava occur very often, because this intervention is characterized with technical difficulties and severe intraoperative complications. The most dangerous of these include massive bleeding, acute heart failure, and pulmonary embolism by tumor masses, which are the most common causes of perioperative mortality. Vena cava trombectomy is a special operation that can be accompanied by heavy bleeding at virtually any stage. The causes and frequency of mortality in 108 patients operated for renal cell carcinoma with growing to the inferior vena cava were retrospectively analyzed. Reliable factors for the prognosis of perioperative mortality in this pathology have been identified. Factors that characterize the tumor thrombus features, as well as parameters related to general condition of a patient, have been found to be of the greatest importance. The results of the study showed that the level of perioperative mortality in caval tumor thrombi is 8.3 % when using surgical methods without artificial circulation. The presented patient population contained a significant proportion of so−called "high" thrombi of III−IV levels, thrombi invading the wall of the inferior vena cava, as well as retrograde spread of intraluminal tumor. The main causes of death were acute heart failure, intraoperative bleeding, pulmonary embolism with tumor masses and acute renal failure. The prognostic value of perioperative mortality was demonstrated by the following thrombus factors: its "high" level, invasion of intraluminal tumor into the caval wall, signs of complete obstruction of caval blood flow. The mortality rate was objectively affected by severe heart failure, signs of pulmonary embolism before surgery. Key words: inferior vena cava, tumor thrombus, renal cell carcinoma, vena cava trombectomy, lethality.