3 research outputs found
Surgical treatment of kidney cancer with extended inferior vena cava thrombosis: complications and long-term results
Objective. Analysis of factors affecting results of inferior vena cava (IVC) thrombectomy in patients with renal cell carcinoma.Materials and methods. Nephrectomy with thrombectomy from IVC was performed in 53 patients (31 (58.5 %) males and 22 (41.5 %) females) with extended thrombosis. Patient age was 35â76 years (mean age 58.7 ± 10.1 years). In 36 (68 %) patients stage Đą3b was determined (mean thrombus length 5.28 ±0.32 cm), in 17 (32 %) patients â stage Đą3Ń (mean thrombus length â 13.00 ±0.71 cm). Postoperative complications were evaluated in accordance with the ClavienâDindo classification. Calculations were performed using statistics software SPSS Statistics 16.Results. No intraoperative complications were observed, mean blood loss was 714 (200â4000) ml. Use of the Cell Saver system allowed to perform reinfusion in the majority of patients. Blood transfusion of 200â500 ml was necessary in 15 patients. In 32 (60.3 %) patients no complications were observed. Grade I complications were observed in 2 (3.7 %) patients, grade II â in 15 (28.3 %) patients, IIIĐ grade â in 2 (3.7 %) patients, and grade IIIĐ â in 1 (1.8 %) patient; there wasnât any grade IV complications. Two (3.8 %) patients died of pulmonary artery thromboembolism. Correlation analysis has shown a high dependency of complications on thrombus size (r = 0.7) and blood loss volume (r = 0.6), and low dependency on tumor size (r = 0.44); complications werenât affected by patientsâ age (r = 0.1) or Karnofsky status (r = 0.0). Median overall survival was 48 months, 3-year survival was 57.1 %, median progression-free survival was 46 months, 3-year progression-free survival was 56.8 %; 90-day morbidity was absent. Three-year overall survival for ŃN0 was significantly higher than for ŃN1 (69 % vs. 25 %; Ń = 0.014). There was no difference in terms of survival between patients with supradiaphragmatic and subdiaphragmatic thrombi (Ń = 0.14).Conclusion. Results of our study show that surgical treatment of patients with renal cell carcinoma and extended IVC thrombosis is effective