RENAL CELL CARCINOMA AND INFERIOR VENA CAVA THROMBOSIS
Keywords:
renal cell carcinoma, inferior vena cava thrombosis, «piggyback» mobilization.Abstract
Summary. It is known that renal cell carcinoma (RCC) isassociated with tumor thrombosis of the inferior vena cava (IVC) in 4–10% cases. Removal of kidney tumors with RCC thrombosis is a complex task in routine surgical practice. Ensuring adequate access to the upper abdominal cavity and retroperitoneal space is often a key factor in large kidney tumors and/or tumor invasion in IVC. Aim: to analize the possibility of adaptation of the orthotopic transplantologic liver technique for the purpose of intraoperative control of the retrohepatic segment of IVC in patients with RCC and (type III–IV) thrombosis. Material and methods: we conducted a retrospective analysis of the combined treatment of cancer patients with RCC based on the National Cancer Registry database. The study included patients with RCC and IVC thrombosis I–IV levels (n=191) who were treated with the surgery from 2008 to 2017 at the clinic of the National Cancer Institute. Results: the stage disease III was in 118 (61.7%) patients and in 73 (38.3%) synchronous distant metastases was found (TNM 7th ed.). IVC thrombosis was diagnosed in 53.4; 16.2; 12.1; 5.2; 4.7; 7.3 and 1.1% cases for levels I, II, IIIa, IIIb, IIIc, IIId and IV, respectively. The average duration of surgery was 215,3 ± 44,1 min, intraoperative blood loss was 639,3 ± 51,7 ml. Time median of IVC and contralateral renal vein ischemia was 23,4 ± 7,9 min. Complications ≥III level registered in 35 (18.3%) cases. The median survival rate was 20.1 and 60.4 months, respectively, for groups with distant metastases and M0 status. Conclusions: if R0-resection is performed in patients with RCC with thrombosis of IVC, it is possible to achieve a total survival of 5-years, regardless of the presence of distant metastases: 44% with the status of pM0, 6% with the status of pM1. The use of the elements of orthotopic liver transplantation in the surgical treatment of patients with RCC with associated IVC thrombosis allows adequate control of the subhepatic segment of the IVC, avoiding the use of cardiopulmonary bypass in patients with IVC thrombosis levels III–IV
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