Surgical treatment of renal tumor with tumor thrombus in the inferior vena cava

Abstract

Background/Aim. An aggressive approach with radical nephrectomy and thrombectomy is the mainstay of the treatment in patients with renal tumors. The aim of this study was to present the results of such surgical procedures performed in the last 25 years at our institution. Methods. We made a retrospective analysis of radical nephrectomy and thrombectomy in patients with renal tumor and tumor thrombus (TT) extending into the inferior vena cava (IVC) operated on at our institution between January 1995 and October 2021. Results. There were 92 patients (72 males and 20 females) aged 60.5 on average who were operated on in the mentioned period. A predominance of right-sided tumors was present in 73.33% of patients. Patients with TT in the renal vein (levels 0 and I) were not included. TT levels II, III, and IV were present in 32 (34.8%), 52 (56.5%), and 8 (8.7%) patients, respectively. One patient had thrombosis of the right pulmonary artery. Four patients had liver metastases, and ten had lymph node involvement. The surgical approach by subcostal incision was achieved in 8 (8.69%) patients, by chevron incision in only 11 (11.95%) patients, while in 73 (79.34%) patients, we performed median sternotomy and subcostal/chevron incision. Intraoperatively, there was one complication which was pulmonary thromboembolism. Six patient required re-exploration after the surgery due to the IVC hemorrhage. The three-year survival in patients with renal tumors and TT levels II?IV in the IVC was 43%. Conclusion. Surgery will remain the primary cure method in patients with renal tumors and TT in the IVC. Long-term survival in these patients can be achieved by complete surgical removal (radical nephrectomy and thrombectomy).