Surgical treatment of the renal cell carcinoma with renal and caval vein involvement — vascular surgeon’s poin of view

Abstract

Introduction: The treatment of renal cell carcinoma in stage with involvement of the vascular structures, especially involvement of inferior caval vein, poses a significant problem for urologist and surgeon. In this review authors presents own experiences concerning the treatment of kidney tumours with involvement of inferior caval vein consequential to spreading the neoplasm into the lumen of vein and/or direct infiltration of its wall.
Material and methods: Between 1996 and 2012 due to tumour of retroperitoneal space involving inferior caval vein 46 patients was operated that required tumour resection with vascular reconstruction, including 38 patients suffering from renal cell carcinoma involving inferior caval vein that results are presented in this review. Described material involve 26 patients (68.5%) in T3 stage of disease and 12 patients in T4 stage of disease (31.5%). Within analyzed group in 37 patients the nephrectomy with resection of inferior caval vein and/or thrombectomy was performed. The continuity of inferior caval vein in 13 cases was reached using vascular prosthesis with end-to-end anastomosis. In other patients was applied direct suture of vein after its marginal tangential resection, vascular patch or suture following inferior caval vein thrombectomy.
Results: Within the early postoperative period 4 deaths (10.5%) and significant complications in 10 patients (26.3%) were reported.
Conclusions: Authors according to their own experiences and literature review discuss about possibilities and difficulties concerned with surgical treatment of patients with renal cell carcinoma and involving inferior caval vein.