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Number №4, 2022 - page 18-31

Surgical treatment of inferior vena cava tumor thrombus DOI: 10.29188/2222-8543-2022-15-4-18-31

For citation: Polotbek uulu Zh., Chevina A.A., Raguzina V.Yu., Ohanyan V.A., Miroshkina I.V., Karelskaya N.A., Stepanova Yu.A., Kochetov A.G., Sapelkin S.V. Surgical treatment of inferior vena cava tumor thrombus. Experimental and Clinical Urology 2022;15(4):18-31; https://doi.org/10.29188/2222-8543-2022-15-4-18-31
Polotbek uulu Zh., Chevina A.A., Raguzina V.Yu., Ohanyan V.A., Miroshkina I.V., Karelskaya N.A., Stepanova Yu.A., Kochetov A.G., Sapelkin S.V.
Information about authors:
  • Polotbek uulu Z. – junior researcher at the Department of Oncourology A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0002-2424-0493
  • Сhevina A.A. – anesthesiologist-resuscitator of the department of anesthesiology-resuscitation with resuscitation and intensive care ward of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0001-8066-2626
  • Raguzina V.Yu. – junior researcher of radiology methods of diagnostics and treatment department of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0002-1527-670Х
  • Oganyan V.A. – junior researcher at the Department of Oncourology A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0002-2059-8703
  • Miroshkina I.V. – junior researcher at the Department of Oncourology A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0002-3208-198X
  • Karelskaya N.A. – Dr.Sc., senior scientific fellow, Radiology department of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0001-8723-8916
  • Stepanova Y.A. – Dr. Sc., Academic Secretary of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia; https://orcid.org/0000-0002-2348-4963
  • Kochetov A.G. – Dr. Sc., Head of the Urological Center of the National Medical research centre of high medical technoligies named after A.A.Vishnevsky of the Ministry of Defense of the Russian Federation, Head of the Department of Urology of the Ministry of Health of the Federal State Educational Institution «Moscow State University of food pruduction»; Moscow, Russia; https://orcid.org/0000‑0003‑3631‑598Х
  • Sapelkin S.V. – Dr.Sc., chief Researcher of the Vascular Surgery Department of the Vishnevsky Na- tional Medical Research Center for Surgery of the Ministry of Health of the Russian Federation; Moscow, Russia; https://orcid.org/0000-0003-3610-8382
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Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors.

Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus.

Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes».

Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented.

Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.

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renal cell carcinoma; venous invasion; tumor thrombus; inferior vena cava; classification; surgical treatment; robot-assisted intervention; clinical and functional outcomes

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