Vol. 8, Issue 4 (2019)

Aim: Analysis of the results of surgical treatment and cumulative survival of patients with renal cell carcinoma, complicated with tumor venous thrombosis.

Material and methods: 83 patients with renal cell carcinoma, complicated with tumor venous thrombosis, were observed at the Vascular surgery department of Lviv Regional Clinical Hospital for the period from 1993 to 2018: 58 (69.9%) men, 23 (27.7%) women, mean age – 58.2 ± 2.3 years; two children (2.4%) 5 and 9 years old. The preoperative instrumental examination included: ultrasound examination of the abdominal cavity, kidneys, computer or magnetic resonance imaging with intravenous contrast enhancement of the abdominal cavity, chest, excretory urography, echo-cardiography and veno-cavagraphy according to indications. Surgical treatment included radical nephrectomy in combination with thrombectomy from the inferior vena cava and right atrium. Kaplan-Meier method and log-rank test were used for survival analysis.

Results and discussion: The intraoperative mortality rate was 4.8%, causes of death - pulmonary embolism and hemorrhagic shock. The causes of postoperative lethality included: pulmonary embolism - in 1 (1.2%), hemorrhagic shock - in 2 (2.4%) cases. Long-term results were evaluated in 76 patients, the median follow-up was 53.2 months. Significantly higher survival rates were observed in patients with renal cell carcinoma with renal vein tumor thrombosis (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=0.20). Regarding to the level of the tumor thrombus of the inferior vena cava there also was no significant difference in survival (p=0.29).

Conclusions: Radical nephrectomy with thrombectomy from the inferior vena cava remains the method of choice in the treatment of patients with renal cell carcinoma, complicated with tumor venous thrombosis. The detailed and timely diagnosis of the prevalence of neoprocess, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications allow to provide acceptable long-term survival rates for patients with renal cell carcinoma with venous invasion.