Technical peculiarities of surgical management for renal cell carcinoma complicated by thrombosis of the renal vein and inferior vena cava.

The capability of renal cell carcinoma for dissemination resulting in formation of a tumour thrombus in the renal vein and inferior vena cava is regarded as one of its clinical peculiarities. At the Departments of the Chelyabinsk Regional Clinical Oncological Dispensary over the period between early 2002 and January 2008 we primarily treated a total of nine hundred and forty-four 43-to-76-year-old (mean age 59.1 years) patients for renal cell carcinoma. Of these, there were 550 (58.3%) men and 394 (41.7%) women. Tumour vascular invasion according to the preoperative examination was detected in 106 (11.2%) patients. Of these, a renal vein involvement was revealed in fifty-three subjects, the involvement of the inferior vena cava (IVC) below the diaphragmatic level in forty, and at the level of the diaphragm and above (IVC ostium) in eleven subjects. A total of eighty-two patients were operated on. Two patients died intraoperatively and a further three patients died in the early postoperative period (up to 3 days). Deaths were caused by pulmonary thromboembolism during surgery in one case and intraoperative blood loss followed by the development of the DIVC syndrome in the remaining cases. The mortality rate thus amounted to 6.1%, with the one- and five-year survival rates equalling 90.0% and 54.1%, respectively. The authors believe that the algorithm of examining the patients presenting with renal cell carcinoma should routinely include methods to diagnose potential thrombotic complications. Once a thrombus is detected, the plan of further examination and appropriate management is to be decided upon with due participation of the vascular surgeon. All preventive measures taken, nephrectomy with thrombectomy from the IVC is associated with low lethality and complication rates.