Extensive operations in kidney cancer complicated by tumor thrombus invasion of the inferior vena cava

: Invasion of renal tumor into retroperitoneal major vessels with thrombosis should be characterized as local spread of renal carcinoma and a serious complication. Extensive interventions were conducted in 30 subjects out of 196 nephrectomy cases. Nephrectomy was attended by colectomy (3 cases), pancreatic resection and adrenalectomy (3 cases), resection of the liver (2 cases), one-stage lobectomy (2 cases), adrenalectomy (9 cases), resection of the uterine appendages (1 case), resection of the colon, splenectomy, opening of an intraorganic abscess. 12 patients underwent thrombectomy from the major vein via the thoracophrenoabdominal approach. Cavathrombectomy was carried out in 7 (3.6%) patients, in 3 of which vena cava inferior was resected. Removal of the thrombus from the renal vein with resection of the opening and suturing of the vena cava inferior was performed in 5 patients. The thrombus originated from the right kidney in 9, while from the left one in 3 patients treated surgically. The thrombi occupied 4-10 cm along the renal vein from its opening. The removed kidney weighted from 400 to 3200 g. One death occurred due to pulmonary embolism during the operation, one on day 5 due to cardiopulmonary insufficiency. Histological examinations of the thrombi showed them to consist of fibrin, blood elements and tumor cells within the thrombus. The thrombi grow slowly, undergo organization and vascularization. Tumor cells multiply in the thrombus. Fibrin coating restricts cancer cell free dissemination via the venous system. Cavathrombectomy is considered the only way to prolong survival for the above patients.