Features and sequence of surgical procedures in tumor of the left kidney with implantation venous thrombus

Abstract

Introduction. Today, the only radical treatment for renal cancer (RC) complicated by a tumor thrombus of the inferior vena cava (IVC) is the surgical one. The use of aggressive surgery, which involves implementation of radical nephrectomy and thrombectomy with IVC, leads to a number of complications that can be prevented by improving the surgical techniques. Purpose. To improve the results of surgical treatment of the left renal cancer complicated by implantation thrombus of IVC by developing a differentiated approach to the access and stages of surgical procedures. Materials and methods. The study included 144 patients with RC complicated by IVC tumor thrombosis. All patients were treated at the Transcarpathian Regional Clinical Hospital named after A. Novak in the period from 2005 to 2019. The age of the patients varied from 27 to 79 years, the average age was 58.4 years. There were 95 men (66%) and 49 women (34%). The level of dissemination of tumor thrombus on IVC was determined according to the classification of the Mayo clinic. The lesion of the left kidney with a tumor took place in 49 (34%) patients, of which 16 (32.7%) patients had 0 level thrombus, 17 (34.7%) – level I, 10 (20.4%) – level II, in 4 (8.2%) – level III, and in 2 – level IV. All patients underwent surgery with a “chevron” or “mercedes” transabdominal approach using the “en block” organ mobilization technique in the right and left abdominal and retroperitoneal regions. Results. The use of the presented stages in the surgical treatment of the left kidney tumors with implantation IVC thrombus let to perform radical intervention in all cases: cavathrombectomy and nephrectomy, without episodes of pulmonary embolism, significant bleeding, and repeated thrombosis. Conclusion. Transabdominal “chevron” or “mercedes” access with the use of the “en block” organ mobilization technique in the right and left parts of the abdominal cavity and retroperitoneal space, full control over the IVC ensure successful radical surgical treatment of patients with the left kidney tumor and implantation venous thrombus.