DIAGNOSIS AND SURGICAL TREATMENT OF THROMBOTIC INVASIONS OF THE INFERIOR VENA CAVA AND RIGHT ATRIUM IN PATIENTS WITH RENAL CELL CARCINOMA

The aim - to improve the diagnosis and results of surgical treatment of thrombotic invasions of the inferior vena cava and right atrium in patients with renal cell carcinoma. Methods. The results of examination and surgical treatment of thrombotic invasions of the inferior vena cava and right atrium were analyzed in 77 patients with renal cell carci-noma, who were hospitalized to the vascular surgery department of the Lviv regional clinical hospital for the period from 1993 to 2018 years. For patients' examination the following methods were used: ultrasonography, computed tomography or magnetic resonance imaging with intravenous contrast enhancement of the abdominal cavity, chest, excretory urography, Echo-cardiography, according to the indications venography also was performed. Results. All patients underwent nephrectomy, retro-peritoneal lymphadenectomy, thrombectomy from the inferior vena cava and right atrium. The median duration of the operation was 240 min; the median blood loss was 940 ml (500 - 3800 ml). Intraoperative autogemotransfusion with the use of the "Cell-Saver Plus" method allowed significantly reduce the volume of blood loss and the need for donor blood. The intraoperative mortality rate was 2.6%. The postoperative complications included: pulmonary embolism - in 5 (6.5%), acute renal failure - in 6 (7.8%), liver failure - in 5 (6.5%), posthemorrhagic anemia - in 24 (31.1%), phlebothrombosis – in 2 (2,6%), suppuration of the postoperative wound - in 3 (3.9%) cases. The causes of postoperative lethality included: pulmonary embolism - in 1 (1.3%), hemorrhagic shock - in 1 (1.3%), pulmonary insuffi-ciency - in 1 (1.3%) case. The follow-up period was from 1 to 22 years. Two-year survival is confirmed in 77.1%. Conclusions. The effectiveness of radical surgery of thrombotic invasions of the inferior vena cava and right atrium in patients with renal cell carcinoma is due to detailed and timely diagnosis of neoprocess prevalence, improvement of surgical tactics, effective prevention of thromboembolic and hemorrhagic complications.