Volume of surgical intervention in renal cancer, complicated by invasion of tumoral thrombus into venous wall

Keywords: renal cancer; tumoral venous thrombus; nephrectomy; thrombectomy; resection of vena cava inferior; prosthesis.

Abstract

Objective. To determine the volume of surgical intervention on vena cava inferior in renal cancer, complicated by invasion of tumoral thrombus into the vein wall.

Materials and methods. Into the investigation were included 147 patients, suffering renal cancer, complicated by tumoral venous thrombosis, who were treated surgically in the Zakarpattya Regional Clinical Hospital named after Andriy Novak or in the Zakarpattya Antitumoral Centre in 2005 - 2020 yrs. The patients’ age varied from 27 to 79 yrs old, their average age have constituted 58 yrs old. There were 97 (66%) men and 50 (34%) women. The null level of venous spread of tumoral thrombus was diagnosed in 55 (37.4%), І – in 32 (21.8%), ІІ – in 30 (20.4%), ІІІ – in 22 (15.0%), and IV - in 8 (5.4%) patients. The tumor was localized in right kidney in 51 (34.7%) patients. Surgical treatment in all the patients was performed - nephrectomy and various interventions on the vein. Longitudinal resection of the vein was performed in 55 (37.4%), resection with suturing of alloflap - in 5 (3.4%), circular resection with prosthesis “end-to-end” - in 4 (2.7%) patients. In the tumoral thrombus localization, including a renal vein, the uxtaosteum resection was performed in 100% of the patients.

Results. Average duration of the operation was 165 (102 - 292) min, average volume of the blood loss - 780 (240 - 2250) ml. Mild and moderate postoperative complications in accordance to classification of Clavien-Dindo (Degree I - II) was registered in 38 (21.8%), and the severe (Degree ІІІ - V) - in 6 (4.1%) patients. Surgical complications of Degree III or complications, which demanded urgent relaparotomy, were not observed. In early postoperative period 1 patient died. General postoperative lethality have constituted 0.7%. In all the patients a laminar blood flow was preserved. In no one patient the prosthesis thrombosis, recurrence of the prosthesis thrombus, recurrence of tumoral venous thrombus or pulmonary thromboembolism.

Conclusion. Radical method of surgical treatment of renal cancer, complicated by tumoral thrombosis of vena cava inferior, must include nephrectomy, cavatomy, thrombectomy, various variants of resection and prosthesis of the vein. In the null level of the tumoral thrombus venous spread the performance of uxtaosteum resection of renal vein is obligatory.

Author Biographies

S. Sh. S. Boiko, Uzhgorod National University

Boiko Serhii Shandor S. - PhD (Med) Student,

Hospital Surgery Department,

Uzhhorod National University

22 Peremohy Str., 88018, Uzhhorod, Ukraine

+38(0312) 61-35-70

123serg.boyko123@gmail.com

https://orcid.org/0000-0003-3016-6901

V. І. Rusin, Uzhgorod National University

Rusin Vasil I. - MD, DSci(Med), Professor

Hospital Surgery Department,

Uzhhorod National University

22 Peremohy Str., 88018, Uzhhorod, Ukraine

+38(0312) 61-35-70

kaf-surgery@uzhnu.edu.ua

https://orcid.org/0000-0001-5688-9951

S. O. Boiko, Uzhgorod National University

Boiko Serhii O. - MD, DSci(Med), Associate Professor,

Hospital Surgery Department,

Uzhhorod National University

22 Peremohy Str., 88018, Uzhhorod, Ukraine

+38(0312) 61-35-70

boiko.likar@gmail.com

ORCID: https://orcid.org/0000-0002-8073-3030

V. V. Rusin, Uzhgorod National University

Rusin Vasil V. - MD, DSci(Med), Associate Professor,

Hospital Surgery Department,

Uzhhorod National University

22 Peremohy Str., 88018, Uzhhorod, Ukraine

+38(0312) 61-35-70

kaf-surgery@uzhnu.edu.ua

https://orcid.org/0000-0003-4854-0228

References

Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004 Jul;94(1):33-41. doi: 10.1111/j.1464-410X.2004.04897.x. PMID: 15217427.

Rabbani F, Hakimian P, Reuter VE, Simmons R, Russo P. Renal vein or inferior vena caval extension in patients with renal cortical tumors: impact of tumor histology. J Urol. 2004 Mar;171(3):1057-61. doi: 10.1097/01.ju.0000112885.66352.e2. PMID: 14767270.

Davydov MI, Matveev VB, Volkova MI, Begaliev AK, Feoktistov PI, Kuznetsov KP, et al. Surgical treatment of renal cell carcinoma with advanced tumor invasion of the inferior vena cava. Cancer Urology. 2017;13(1):27-36. Russian. doi: 10.17650/1726-9776-2017-13-1-27-36.

Davydov MI, Matveev VB, Volkova MI, Figurin KM, Chernyaev VA, Klimov AM, et al. Resection of the inferior vena cava in patients with renal cell carcinoma with bulky tumor venous thrombosis. Cancer Urology. 2018;14(2):15-25. Russian. doi: 10.17650/1726-9776-2018-14-2-15-25.

Ayyathurai R, Garcia-Roig M, Gorin MA, González J, Manoharan M, Kava BR, Soloway MS, Ciancio G. Bland thrombus association with tumour thrombus in renal cell carcinoma: analysis of surgical significance and role of inferior vena caval interruption. BJU Int. 2012 Dec;110(11 Pt B):E449-55. doi: 10.1111/j.1464-410X.2012.11128.x. Epub 2012 Apr 30. PMID: 22540981.

Feng X, Bao J, Jing Z, Hou J, Gao X. Tempofilter II for tumor emboli prevention during radical nephrectomy and inferior vena cava thrombus resection for renal cell carcinoma. J Surg Oncol. 2009 Aug 1;100(2):159-62. doi: 10.1002/jso.21303. PMID: 19418494.

Kirkali Z, Van Poppel H. A critical analysis of surgery for kidney cancer with vena cava invasion. Eur Urol. 2007 Sep;52(3):658-62. doi: 10.1016/j.eururo.2007.05.009. Epub 2007 May 24. PMID: 17548146.

Rusin VI, Korsak VV, Popovich YM, Boyko SO, Lurin IA, Boldizhar PO, et al. Surgical treatment of inferior vena cava thrombosis. Uzhhorod: Carpathians; 2017. 360 p. Ukrainian. ISBN 978-966-2095-53-1.

Psutka SP, Boorjian SA, Thompson RH, Schmit GD, Schmitz JJ, Bower TC, Stewart SB, Lohse CM, Cheville JC, Leibovich BC. Clinical and radiographic predictors of the need for inferior vena cava resection during nephrectomy for patients with renal cell carcinoma and caval tumour thrombus. BJU Int. 2015 Sep;116(3):388-96. doi: 10.1111/bju.13005. Epub 2015 Mar 23. PMID: 25430786.

Stilidi IS, Abgaryan MG, Kalinin AE, Berdnikov SN. Surgical treatment of patients with leiomyosarcoma of inferior vena cava. Khirurgiia (Mosk). 2017;(10):4-12. Russian. doi: 10.17116/hirurgia2017104-12. PMID: 29076476.

Caso J, Seigne J, Back M, Spiess PE, Pow-Sang J, Sexton WJ. Circumferential resection of the inferior vena cava for primary and recurrent malignant tumors. J Urol. 2009 Sep;182(3):887-93. doi: 10.1016/j.juro.2009.05.015. Epub 2009 Jul 17. PMID: 19616230.

Goto H, Hashimoto M, Akamatsu D, Shimizu T, Miyama N, Tsuchida K, et al. Surgical resection and inferior vena cava reconstruction for treatment of the malignant tumor: technical success and outcomes. Ann Vasc Dis. 2014;7(2):120-6. doi: 10.3400/avd.oa.13-00125. Epub 2014 Mar 15. PMID: 24995055; PMCID: PMC4072859.

González J, Gorin MA, Garcia-Roig M, Ciancio G. Inferior vena cava resection and reconstruction: technical considerations in the surgical management of renal cell carcinoma with tumor thrombus. Urol Oncol. 2014 Jan;32(1):34.e19-26. doi: 10.1016/j.urolonc.2013.01.004. Epub 2013 Mar 15. PMID: 23499500.

Hyams ES, Pierorazio PM, Shah A, Lum YW, Black J, Allaf ME. Graft reconstruction of inferior vena cava for renal cell carcinoma stage pT3b or greater. Urology. 2011 Oct;78(4):838-43. doi: 10.1016/j.urology.2011.06.016. Epub 2011 Aug 6. PMID: 21821277.

Abel EJ, Carrasco A, Karam J, Tamboli P, Delacroix S, Vaporciyan AA, Wood CG. Positive vascular wall margins have minimal impact on cancer outcomes in patients with non-metastatic renal cell carcinoma (RCC) with tumour thrombus. BJU Int. 2014 Nov;114(5):667-73. doi: 10.1111/bju.12515. Epub 2014 Feb 19. PMID: 24128265.

Published
2021-10-28
How to Cite
Boiko, S. S. S., RusinV. І., Boiko, S. O., & Rusin, V. V. (2021). Volume of surgical intervention in renal cancer, complicated by invasion of tumoral thrombus into venous wall. Klinicheskaia Khirurgiia, 88(5-6), 28-35. https://doi.org/10.26779/2522-1396.2021.5-6.28
Section
General Problems of Surgery