C229: Treatment of renal cell carcinoma with tumor thrombus in vena cava inferior-own experiences

Różański W.1, Markowski M.1, Wrona M.1, Lipiński P.1, Lipiński M.1, Stelągowski M.2

1Medical University Of Lodz, Dept. of Urology, Lodz, Poland, 2Copernicus Memorial Hospital In Lodz, Dept. of General and Vascular Surgery, Lodz, Poland

INTRODUCTION & OBJECTIVES: Renal cell carcinoma (RCC) with tumor thrombus in vena cava inferior (IVC) is a serious therapeutical problem. The decision about the operation in very often difficult to make, because operating procedure is complicated. The aim of this study is to present experiences in treatment of RCC with tumor thrombus.

MATERIAL & METHODS: Between February 2014 and May 2014 in II Clinic of Urology, Medical University of Lodz, Poland have been operated 3 patients with RCC with tumor thrombus in vena cava inferior. First patient, 71 years old man with RCC 7 cm in diameter and 5 cm tumor thrombus in IVC. Second patient, 77 years old man with enormous RCC in standard CT there was no possibility to precisely described the length of tumor thrombus in IVC. Third patient, 65 old man, with RCC 7 cm in diameter with 7 cm in length tumor thrombus in IVC. All patients before admission to the hospital had CT scan and chest X-ray there were no signs of distant metastases. To every operation were prepared 10 unit of blood concentrate and 10 units of fresh frozen plasma. All patients were operated by transperitoneal approach. After resection of kidney with RCC the next step of the operation was the clear IVS from tumor thrombus. In one case there was only incision of IVC with removing of tumor thrombus and in 2 vases there were need to insert vascular prosthesis. During the operation and postoperation period there was necessity of blood and plasma transfusion – in average it were 3 blood units and 2 plasma units. There were not postoperative complications. All patients were discharged from hospital in good general condition. Medium stay in hospital was 13 days (the ranged was from 12 to 14 days).

RESULTS: All patients up to present day are under control in outpatients clinic. In one patient there are symptoms of distant metastases in lung. In other two cases there is no evidence of progression of neoplasmatic progress.

CONCLUSIONS: Operation procedure in case of renal cell carcinoma with tumor thrombus in vena cava inferior is still not everyday operation. The result of CT scan very often can be discouraging for a surgeon. Operation is very demandable of skills and technique. Also it is an operation with high risk of complication for the patients. But as our experiences show it can the lifesaving procedure and is patients last hope.

Eur Urol Suppl 2014; 13(6) e1392