Abstract
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.
Highlights
Nephrectomy, thrombectomy, perirenal inferior vena cava (IVC) region resection with replacement of the venous wall defect with a polytetrafluoroethylene patch: a – cancer of the right kidney with invasive thrombus of more than 50 % of the perirenal IVC region perimeter; б, в – nephrectomy, thrombectomy, perirenal IVC region resection with replacement of the venous wall defect with a polytetrafluoroethylene patch
Abel E.J., Houston Thompson R., Margulis V. et al Perioperative outcomes following surgical resection of renal cell carcinoma with inferior vena cava thrombus extending above the hepatic veins: a contemporary multicenter experience
Summary
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. 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. У всех пациентов имела место опухоль почки (правой – 36 (73,5 %), левой – 13 (26,5 %)). Тромбоз инфраренального отдела НПВ имел место у 28 (57,1 %), общих подвздошных вен – у 19 (38,8 %), вен нижних конечностей – у 11 (22,4 %) пациентов. Мобилизация правой почки осуществлялась непосредственно перед удалением тромба после перевязки почечной артерии и изоляции вовлеченного сегмента НПВ. Мобилизация левой поч ки и нефрэктомия выполнялись после перевязки почечной артерии и удаления тромба из просвета НПВ. Характеристика больных раком почки с массивной опухолевой инвазией НПВ (n = 49). Тромбоз инфраренального отдела НПВ Thrombosis of the infrarenal segment of the IVC
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