Хирургическое лечение рака почки с протяженными тромбами нижней полой вены: осложнения и отдаленные результаты

Objective. Analysis of factors affecting results of inferior vena cava (IVC) thrombectomy in patients with renal cell carcinoma. Materials and methods . Nephrectomy with thrombectomy from IVC was performed in 53 patients (31 (58.5 %) males and 22 (41.5 %) females) with extended thrombosis. Patient age was 35–76 years (mean age 58.7 ± 10.1 years). In 36 (68 %) patients stage Т3b was determined (mean thrombus length 5.28 ±0.32 cm), in 17 (32 %) patients – stage Т3с (mean thrombus length – 13.00 ±0.71 cm). Postoperative complications were evaluated in accordance with the Clavien–Dindo classification. Calculations were performed using statistics software SPSS Statistics 16. Results. No intraoperative complications were observed, mean blood loss was 714 (200–4000) ml. Use of the Cell Saver system allowed to perform reinfusion in the majority of patients. Blood transfusion of 200–500 ml was necessary in 15 patients. In 32 (60.3 %) patients no complications were observed. Grade I complications were observed in 2 (3.7 %) patients, grade II – in 15 (28.3 %) patients, IIIА grade – in 2 (3.7 %) patients, and grade IIIВ – in 1 (1.8 %) patient; there wasn’t any grade IV complications. Two (3.8 %) patients died of pulmonary artery thromboembolism. Correlation analysis has shown a high dependency of complications on thrombus size (r = 0.7) and blood loss volume (r = 0.6), and low dependency on tumor size (r = 0.44); complications weren’t affected by patients’ age (r = 0.1) or Karnofsky status (r = 0.0). Median overall survival was 48 months, 3-year survival was 57.1 %, median progression-free survival was 46 months, 3-year progression-free survival was 56.8 %; 90-day morbidity was absent. Three-year overall survival for рN0 was significantly higher than for рN1 (69 % vs. 25 %; р = 0.014). There was no difference in terms of survival between patients with supradiaphragmatic and subdiaphragmatic thrombi (р = 0.14). Conclusion . Results of our study show that surgical treatment of patients with renal cell carcinoma and extended IVC thrombosis is effective.