Comparative analysis of the results of surgical treatment of kidney cancer complicated by tumor thrombosis of renal vein and inferior vena cava of level I–II

Objective. To analyze the data of patients with kidney cancer complicated by tumor venous thrombosis of the renal vein and inferior vena cava of levels 1–2 who underwent laparotomic and laparoscopic surgical treatment. Materials and methods. A study of 100 patients diagnosed with kidney cancer complicated by tumor venous thrombosis of the renal vein and inferior vena cava of levels 1–2 was conducted at Russian Research Center for Radiology and Surgical Technologies named after Academician A.M. Granov in the period from 2007–2024. 50 (n = 50) patients underwent open surgery, and the rest 50 (n = 50) patients underwent laparoscopic surgery. In the group of patients with laparoscopic surgery, in 8 (n = 8) patients, conversion of approach was performed which resulted in tumor thrombus invasion into the inferior vena cava (IVC) wall; adhesive disease; uncontrolled bleeding. Results. The median duration of laparoscopic surgery was 127.5 (115–155) min and surgery with laparotomy approach –132.5 (110–155) min, p = 0.4006. The median volume of blood loss in endoscopic approach was 200 (150–300) ml, in laparotomy – 250 (200–350) ml, p = 0.0105. Postoperative complications of the first class according to the Clavien–Dindo classification were observed in 20 patients (20 %), those of the second class were in 8 patients (8 %), 3 patients (3 %) had the third-class severity and the 4th class severity was noted in 2 patients (2 %). The median duration of hospital stay was 9 days for open surgery (8–10) and 7 days in laparoscopy (7–8), p 0.001. Conclusions. The data of the conducted study demonstrate the effectiveness of classical nephrectomy with thrombectomy for patients diagnosed with kidney cancer complicated by tumor venous thrombosis of the renal vein and inferior vena cava of levels 1–2. Conventional laparotomic nephrectomy with thrombectomy is the gold standard for the treatment of locally advanced renal cell cancer in stage pT3a and pT3b, but laparoscopic approach acts as an effective alternative. The above study clearly demonstrates it.