Surgical treatment of Renal Cell Carcinoma (RCC) with level III–IV tumor venous thrombosis

Autor:	K. P. Kuznetsov, K. M. Figurin, P. I. Feoktistov, V. B. Matveev, M. I. Volkova, V.A. Chernyaev, O. V. Zhuzhginova, I. V. Nekhaev, M.I. Davydov, S. V. Lomidze, E. V. Ogorodnikova
Rok vydání:	2016
Předmět:	medicine.medical_specialty business.industry Urology kidney cancer medicine.disease Surgery Venous thrombosis Oncology thrombectomy Nephrology Renal cell carcinoma medicine venous tumor thrombus Medicine Radiology Nuclear Medicine and imaging Level iii Radiology business Surgical treatment
Zdroj:	Onkourologiâ, Vol 12, Iss 4, Pp 21-34 (2016)
ISSN:	1996-1812 1726-9776
Popis:	Objective: to assess the results of nephrectomy, thrombectomy in RCC patients with level III–IV tumor venous thrombosis with and without cardiopulmonary bypass.Materials and methods. Medical data of 167 consecutive RCC patients with level III–IV tumor venous thrombosis underwent nephrectomy thrombectomy in N.N. Blokhin Russian Cancer Research Center between 1998 and 2012 were collected. Right side tumor was in 122 (73.1 %), left side – in 42 (25.1 %), bilateral – in 3 (1.8 %) cases. The extent of thrombus was defined as intrahepatic in 82 (49.1 %), supradiaphragmatic – in 85 (50.9 %) (intrapericardial – in 44 (26.3 %), intraatrial – in 39 (23.4 %), intraventricular – in 2 (1.2 %)) cases. Nephrectomy, thrombectomy with cardiopulmonary bypass was used in 9 (5.4 %), 158 (94.6 %) patients underwent radical nephrectomy with thrombectomy without CPBP and sternotomy. Intrapericardial IVC and right atrium were exposed through transdiaphragmatic approach and providing vascular control over infradiaphragmatic IVC and renal veins.Results. Median blood loss was 6000 (600–27 000) ml. Complications rate was 62.8 %, 90-day mortality – 13.2 %. Intraoperative complications were registered in 80 (47.9 %), postoperative – in 66 (40.5 %) (grade II – 16 (9.8 %), grade IIIb – 1 (0.6 %), grade IVа – 28 (17.2 %), grade IVb – 3 (1.8 %), grade V – 18 (11.1 %)) patients. Modified thrombectomy technique insignificantly decreased blood loss compared to thrombectomy with CPB, did nоt increase complications rate including pulmonary vein thromboembolism, or mortality. Five-year overall, cancer-specific and recurrence-free survival was 46.2, 58.3 and 47.1 %, respectively. Thrombectomy technique did nоt affect survival.Conclusion. In selected patients with mobile thrombi transdiaphragmatic approach allows to avoid the use of CPBP and decrease surgical morbidity without survival compromising.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c64a5118da356cea2c6f30a394724ee9 https://doi.org/10.17650/1726-9776-2016-12-4-21-34 Zobrazit plný text záznamu