PROGNOSTIC FACTORS OF INTRAOPERATIVE BLEEDING DURING REMOVAL OF KIDNEY TUMORS WITH NEOPLASTIC IVC THROMBUS

INTRODUCTION. Intraoperative bleeding is one of the main problems of venacathrombectomy when removing kidney tumors. We evaluated the volume of intraoperative bleeding in patients who underwent removal of renal tumors with neoplastic IVC thrombi and analyzed the prognostic factors of massive bleeding during this operation. MATERIAL AND METHODS. 78 (62.9%) men and 46 (37.1%) women were included in the study. The average age of the patients was 58.4±10.5 years. Right-sided tumors occurred in 82 (66.1%) cases, left-sided tumors in 42 (33.9%). Caval thrombi had Mayo levels I, II, III and IV in 35 (28.2%), 36 (29%), 27 (21.8%) and 26 (21%) observations respectively. All operations were performed without artificial blood circulation. In patients with III–IV thrombus level we used an organ transplant-based approach. RESULTS. Average volume of blood loss reached 2132.3±1615.9 ml. Among the tumor factors the size of the kidney tumor greater than 10 cm and the left-sided localization of the neoplasm had statistical significance. Of the 7 studied patient factors, only ECOG 2, glomerular filtration rate <60 mL/min, and severe heart failure had high predictive vali¬dity. In fact, all tumor thrombus parameters, except the consistency of intraluminal masses, were significant for predicting a high volume of bleeding and the frequency of massive bleeding. Discriminant analysis showed that the presence of IVC syndrome, ECOG 2, thrombus III-IV level and thrombus diameter are the most important in predicting massive blood loss. Based on these data, a prognostic model was created, which allows the prediction of bleeding of a large volume (>3 L) during such operations. CONCLUSION. The rate of intraoperative blood loss during radical nephrectomy with caval thrombectomy objectively depends on factors related to the renal tumor, the patient, and the tumor thrombus. The most significant prognostic parameters are the presence of IVC syndrome, ECOG 2, thrombus III–IV level and thrombus diameter. The proposed prognostic model containing these factors allows to identify patients with the high risk of massive intraoperative bleeding and help the surgeon to carefully prepare for these complex and dangerous operations.