[Neoplastic thrombosis of the inferior vena cava in kidney carcinoma]

Neoplastic thromboses of the inferior vena cava occur in about 4-15% of patients with conventional, clear-cell renal carcinoma, and significantly increase intraoperative mortality and morbidity rates.

Assessment of outcomes of radical nephrectomies with inferior vena cava thrombectomies, performed in the PlzeN Faculty Hospital from 01-01-1999 to 31-12-2008. PATIENT GROUPS AND METHODS: The study included 16 patients, 12 males and 4 females of 63.6 years of age on average (44-75 y.o.a), suffering from conventional, clear-cell renal carcinoma and neoplastic thrombosis of the inferior vena cava. The main symptoms included hematuris in 7 subjects (43.8%), lumbar pressure pain in 4 subjects (25%), leg edema in 2 subjects (12.5%). In 2 patients (12.5%), the finding was accidental and in 1 patient (6.3%), the symptoms were caused by distant metastases. The diagnostic methods included duplex sonography, multidetector computed tomography, magnetic resonance imaging and cavography. In three subjects, the thrombus was located in the renal vein only (grade I), in 9 subjects, the thrombus propagated below the entry of the hepatic veins (grade II), in 3 subjects, the thrombus extended above the entry of the hepatic veins (grade III) and, in 1 patient, it reached the right atrium (grade IV). All the patients underwent transabdominal radical nephrectomy (pT3b,c,pN0-2,pM 0-1) and inferior vena cava thrombectomy.

The average duration of IVC closure using vascular clips was 6.3 minutes (3-12 minutes), the average blood loss was 1.7 litres. The intraoperativev mortality rate of the whole study group was 0%. In a single patient, an incompletely removed thrombus resulted in massive pulmonary embolization on day 3, which was urgently managed by cardiosurgery with extracorporeal circulation, when the thrombotic mass was removed from the pulmonary artery. Three subjects (18.8%) died due to generalization of the underlying disease 5-17 months after the primary procedure. Two subjects (12.5%) are currently receiving symptomatic treatment for their generalized underlying disease. 11 subjects (68.8%) show no signs of a relaps of the underlying disease at 3 month-5 years after the procedure.

Radical nephrectomy combined with complete removal of the neoplastic thrombus provides the best prospects for long-term survival rates of the patients.