Renal cell carcinoma, complicated by thrombosis of the inferior vena cava and the right atrium

Abstract

Aim. To analyze the contemporary views of the relevance, features of classification, clinical course, diagnosis and treatment of renal cell carcinoma, complicated by thrombosis of the inferior vena cava and the right atrium. Material and Methods. The publications on the topic over the period of 2004-2017 were analyzed. Fifty-seven primary sources were selected, reflecting the relevance, features of classification, clinical course, diagnosis and treatment of renal cell carcinoma, complicated by thrombosis of the inferior vena cava and the right atrium. Results and Discussion. A specific feature of renal cell carcinoma is the predisposition to vascular invasion with the formation of tumorous thrombi in the renal vein and inferior vena cava in 4-10% of cases, sometimes spreading to the right atrium. Frequency of 5-year survival of patients with renal cell carcinoma, complicated with venous invasion, at the absence of distant metastases, is 40-69%, while the intravenous spreading is not considered a criterion for dissemination of the tumorous process in the postoperative period. Therefore, radical nephrectomy with caval thrombectomy remains the method of choice in treating such patients . Despite the improvements in the techniques of caval thrombectomy, surgical treatment continues to be technically difficult, associated with a high incidence of complications and mortality, especially in the removal of tumorous thrombi of the retrohepatic and supradiaphragmatic parts of the inferior vena cava and the right atrium. Extremely important for the safe removal of the tumorous thrombi is the preoperative assessment of the prevalence of neoprocesses, the presence of venous wall invasion, of hepatic veins (Budd-Chiari syndrome), as well as optimal prevention of thromboembolic and hemorrhagic complications. Conclusions. Radical surgery remains the method of choice in the treatment of renal cell carcinoma complicated with thrombosis of the inferior vena cava and the right atrium. The analysis of literary sources revealed evidence of the high efficiency of radical nephrectomy in combination with caval thrombectomy, which is conditioned by timely diagnosis of the neoprocess spreading, improvement of of surgical treatment strategy, and optimal prevention of severe hemorrhagic and thromboembolic complications, which would provide satisfactory long-term results.

Keywords

• renal cell carcinoma, tumorous thrombus, inferior vena cava, right atrium, diagnosis, treatment