RENAL CANCER WITH METASTATIC THROMBUS IN THE INFERIOR VENA CAVA: MULTIDISCIPLINARY SURGICAL APPROACH

Abstract

Objectives. Kidney cancer is the 6th most diagnosed cancer in the world, with a mortality rate of 4.4%. Malignant renal tumors are characterized by tumoral thrombosis in the venous system in 4-14% of the total number of diagnosed cases. The aim of the study was to highlight the importance of applying surgical treatment in renal cancers with metastatic thrombus in the main vessels and optimizing the applied surgical techniques.

Material and methods. This outwork is based on a retrospective study, analyzing the medical records of 39 patients. The surgical approach was median laparotomy 29 (74,36%), Leclerc “Mercedes” laparotomy 6 (15,38%), Leclerc “Mercedes” sternolaparotomy – 3 (7,69%), sternolaparotomy – 1 (2,56%).
Results. The average duration of the surgery was 315±18,7 minutes. The average intraoperative hemorrhage consisted of 1900±158 ml. The average duration of postoperative hospitalization was 10±2,1 days. Perioperative death occurred in 2 (5,12%) cases. The early postoperative period was uncomplicated in 35 cases and involved reoperation for surgical hemostasis in 4 (10,25%) cases. Tumor cell invasion of the inferior vena cava wall has been histologically confirmed.

Conclusions. The approach and surgical techniques applied in the clinic are the basic standard in achieving maximum intraoperative safety to minimize the risk of bleeding, pulmonary thromboembolism and intraoperative death.