[COMPLICATIONS OF SURGICAL TREATMENT OF A RENAL—CELL CANCER WITH INTRAVENOUS SPREADING]

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Renal cell carcinoma (RCC) with tumor thrombus formation presents a complex surgical challenge.
• Tumoral thrombi extending into the inferior vena cava (VCI) are associated with poorer prognoses and increased operative risks.

Purpose of the Study:

• To estimate the rate of perioperative complications in patients undergoing surgical treatment for renal cell cancer with tumoral thrombi.
• To identify factors associated with increased perioperative morbidity in this patient cohort.

Main Methods:

• Retrospective investigation of 132 patients with renal cell carcinoma and tumoral thrombi.
• Surgical approach utilized was the "chevron" access without cardiopulmonary bypass.
• Data collected included tumor thrombus extent, operative details, and perioperative complications.

Main Results:

• The overall perioperative complication rate was 56.8% in patients with macroscopic tumoral thrombi.
• Tumoral thrombus extension into the inferior vena cava (VCI) was associated with a significantly higher complication rate (p<0.05).
• Factors identified as unfavorable included cardiac insufficiency, VCI wall invasion, retrograde thrombus spread with concurrent VCI thrombosis, and ECOG scores >1.

Conclusions:

• Surgical management of renal cell cancer with tumoral thrombi, especially with VCI involvement, carries a substantial risk of perioperative complications.
• Pre-existing cardiac conditions, extent of tumor invasion, and patient's performance status (ECOG) are critical factors influencing outcomes.