Surgical treatment of patients with renal cancer with supradiaphragmatic and intraventricular tumour thrombi of inferior vena cava
The objective. To study the results of nephrectomy with thrombectomy from the inferior vena cava (IVC) in supradiaphragmatic and intraventricular tumour thrombi in patients with renal cell carcinoma (RCC). Patients and methods. Since 2007 until now, nephrectomy with thrombectomy from IVC has been performed in 10 patients: 4 (40%) with supradiaphragmatic tumour thrombi and 6 (60%) with intraventricular ones. There were 4 (40%) males and 6 (60%) females. The patients aged 35 to 71 years (57.1 ± 11.4). Eight (80%) patients had a marked clinical picture of IVC syndrome. All patients complained of abdominal pains, haematuria was found in 8 (80%) patients; fever, weakness, weight loss -in 9 (90%) patients. In 7 (70%) cases thrombus originated from the right kidney, in 3 (30%) - from the left kidney. The average length of thrombus was 14.1 ± 1.3 cm (12-15). 90-day complications were analyzed according to Clavien classification. Results. No intra-operative complications have been recorded. Blood loss averaged 1130 ± 565 ml (500-2000 ml). Reinfusion was performed by a Cell-Saver device in 6 (60%) patients (the volume of reinfusion- from 200 to 900 ml). Haemotransfusion was required only in 5 (50%) patients in the volume not more than 500 ml (250- 500 ml). Complications grade 3-5 developed in 3 (30%) patients. Complications grade 3a were diagnosed in 1 (10%) patient, which necessitated drainage of the pericardium due to haemopericardium with local anaesthesia. Complications grade 3b - ischaemic necrosis and perforation of the descending colon were found in 1 (10%) patient, due to which relaparotomy and colostomy was performed with subsequent coloplasty. One (10%) patient died of pulmonary thromboembolism. Conclusion. Surgical treatment of patients with supradiaphragmatic and intraventricular tumour thrombi of IVC in RCC remains a complex problem. Such patients have a high risk for development of perioperative complications. Improvement of surgical equipment, anaesthesiological and resuscitation devices help reduce the number and severity of complications.