Surgical treatment of renal cell carcinoma with thrombosis of inferior vena cava and right atrium

Abstract

The aim — to improve the diagnosis and surgical treatment results of renal cell carcinoma, complicated with thrombosis of the inferior vena cava and right atrium.Materials and methods. The results of clinical examination, laboratory indicators, instrumental, intraoperative observations and morphological studies were analysed in 76 patients with renal cell carcinoma, complicated with thrombosis of the inferior vena cava and right atrium, who were hospitalized to the Vascular Surgery department for the period from 1993 to 2017 years.Results and discussion. Surgical treatment included radical nephrectomy in combination with thrombectomy from the inferior vena cava and right atrium. The average operation duration was 220 min, the median blood loss was 900 ml (500 — 3000 ml). Intraoperative autogemotransfusion with the «Cell­Saver Plus» method allowed to reduce significantly the blood loss and the donor blood need. The intraoperative mortality rate was 2.6 %. The postoperative complications included: pulmonary embolism — in 5 (6.6 %), acute renal failure — in 6 (7.9 %), liver failure — in 5 (6.6 %), posthemorrhagic anemia — in 23 (30.2 %), phlebothrombosis — in 2 (2.6 %), suppuration of the postoperative wound — in 3 (3.9 %) cases. The causes of postoperative lethality included: pulmonary embolism — in 1 (1.3 %), hemorrhagic shock — in 1 (1.3 %), pulmonary insufficiency — in 1 (1.3 %) case. The follow­up period was from 1 to 22 years. Two­year survival was confirmed in 77.1 %.Conclusions. The choice of optimal tactics for surgical intervention in patients with renal cell carcinoma, complicated with thrombosis of the inferior vena cava and right atrium, is determined by the different levels of venous invasion, which, in the context of a multidisciplinary approach, will minimize the risk of intra­ and postoperative complications, and improve long­term treatment outcomes.