Surgery in Patients with Renal Cell Carcinoma and Tumor Thrombus of Inferior Vena Cava

Objective. To present surgical treatment of patients with renal cell carcinoma complicated by tumor thrombosis of inferior vena cava. Material and methods. Surgical interventions were performed in 21 patients (mean age 59 years) with renal cell carcinoma T3b and T3c, N0-1, M0 stage. There were 17 (81%) men and 4 (19%) women. Tumor thrombosis of inferior vena cava arose from the right kidney in 16 (76%) cases and left kidney in 5 (24%) cases. All patients underwent nephrectomy and different types of thrombectomy from inferior vena cava with subsequent lymph node dissection. All patients received postoperative anticoagulant therapy. Results. Inferior vena cava patency was restored in all cases. Postoperative mortality was 9.5%. We estimated treatment outcomes throughout a year in 84% of cases. Thrombotic recurrent occlusion of infrarenal IVC occurred in 2 out of 5 patients. There was no recurrent thrombosis of suprarenal IVC and contralateral renal vein. Fatal outcome occurred in 4 patients in 5, 7, 8 and 11 months after surgery from progression of cancer. Annual survival rate was 75%. Conclusion. Surgery for renal cell carcinoma complicated by tumor thrombosis of IVC should include vein recanalization. This intervention is relatively safe and associated with higher annual survival.