Surgical treatment of renal tumor with tumor thrombus in the inferior vena cava

  • Aleksandar Tomić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Predrag Aleksić Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Novak Milović Military Medical Academy, Clinic for Urology, Belgrade, Serbia
  • Radoje Ilić Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Ivan Marjanović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Vladimir Bančević Military Medical Academy, Clinic for Urology Belgrade, Serbia
  • Ivan Leković Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Vojislava Nešković Military Medical Academy, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia
  • Vladimir Mandarić Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Zoran Kostić Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia
  • Momir Šarac Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Petar Vukićević Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Boško Milev Military Medical Academy, Clinic for General Surgery, Belgrade, Serbia
  • Dragana Paunović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Aleksandar Zarić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Military Medical Academy, Clinic for Anesthesiology and Intensive Care, Belgrade, Serbia
  • Dragan Sekulić Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
  • Luka Babić Military Medical Academy, Clinic for Cardiosurgery, Belgrade, Serbia
  • Radivoj Zoranović Military Medical Academy, Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP220130058T
Keywords: kidney neoplasms, neoplasm metastasis, vena cava, inferior, surgical procedures, operative, survival

Abstract


Background/Aim. An aggressive approach with radical nephrectomy and thrombectomy is the mainstay of the treatment in patients with renal tumors. The aim of this study was to present the results of such surgical procedures performed in the last 25 years at our institution. Methods. We made a retrospective analysis of radical nephrectomy and thrombectomy in patients with renal tumor and tumor thrombus (TT) extending into the inferior vena cava (IVC) operated on at our institution between January 1995 and October 2021. Results. There were 92 patients (72 males and 20 females) aged 60.5 on average who were operated on in the mentioned period. A predominance of right-sided tumors was present in 73.33% of patients. Patients with TT in the renal vein (levels 0 and I) were not included. TT levels II, III, and IV were present in 32 (34.8%), 52 (56.5%), and 8 (8.7%) patients, respectively. One patient had thrombosis of the right pulmonary artery. Four patients had liver metastases, and ten had lymph node involvement. The surgical approach by subcostal incision was achieved in 8 (8.69%) patients, by chevron incision in only 11 (11.95%) patients, while in 73 (79.34%) patients, we performed median sternotomy and subcostal/chevron incision. Intraoperatively, there was one complication which was pulmonary thromboembolism. Six patient required re-exploration after the surgery due to the IVC hemorrhage. The three-year survival in patients with renal tumors and TT levels II−IV in the IVC was 43%. Conclusion. Surgery will remain the primary cure method in patients with renal tumors and TT in the IVC. Long-term survival in these patients can be achieved by complete surgical removal (radical nephrectomy and thrombectomy).

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Published
2023/05/03
Issue
Vol. 80 No. 04 (2023): Vojnosanitetski pregled
Section
Original Paper