Tumor thrombosis of the inferior vena cava and right atrium in patients with renal cell carcinoma: 25-year experience of surgical treatment
Aim. To improve the results of surgical treatment of tumor thrombosis of the inferior vena cava and right atrium in patients with renal cell carcinoma.
Materials and Methods. The results of clinical examination, laboratory, instrumental, intraoperative observations and morphological studies were analyzed in 83 patients with renal cell carcinoma, complicated with tumor venous thrombosis, who were hospitalized to the vascular surgery department of Lviv regional clinical hospital for the period from 1993 to 2018. For a comparative analysis, all patients were divided into two groups: the first, main, group included 61 patients (39 men and 20 women, mean age 58,1±2,7 years old; two children, 5 and 9 years old) with renal cell carcinoma, complicated with tumor thrombosis of inferior vena cava and right atrium. The second, control, group included 22 patients (19 men and 3 women, mean age 58,3±4,3 years old) with renal cell carcinoma and renal vein invasion. Thepatients’ examination included laboratory and instrumental methods: ultrasound; computer or magnetic resonance imaging with intravenous contrast enhancement of the abdominal and chest cavity;excretory urography; echo-cardiography; veno-cavagraphy according to indications. Kaplan-Meier method was used to evaluate the long-term survival of patients with renal cell carcinoma, complicated with tumor venous thrombosis.
Results and Discussions. Surgical treatment included radical nephrectomy in combination with thrombectomy from the inferior vena cava and right atrium. The using of Cell-Saver system has significantly reduced the need for donor blood. Despite the significant volume and trauma of surgical interventions in patients of the first group, the risk of most postoperative complications did not predominate in eithergroup. Survival indicators were evaluated among 76 patients with renal cell carcinoma, complicated with venous invasion - in 55 patients of the first and 21 patients of the second group. The median follow-up was 53,2 months. The median survival rate for patients in the first group was 33,3 months; for patients in the second group - 118,2 months. The cumulative 2-, 5-, and 10-year survival rates for patients in the second group (80,0%, 59,1%, 52,5%) were significantly higher compared to the first group (57,8%, 38,5%, 23,4%) (p<0,05). At the same time, there was no significant difference in survival among patients with renal cell carcinoma, complicated with tumor venous thrombosis, without and with metastases (p>0,2). Regarding the level of the tumor thrombus of the inferior vena cava, there was no significant difference in survival as well (p>0,29).
Conclusions. A detailed preoperative assessment of the prevalence of neoprocess, the improvement of surgical procedure, an effective prevention of thromboembolic and hemorrhagic complications allow providing acceptable long-term survival rates of patients with renal cell carcinoma with venous invasion.
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