Feasibility and safety of some surgical maneuvers during vena cava thrombectomy in patients with intravenous spread of renal cell carcinoma

The aim of the study is to analyse the feasibility and safety of some complex surgical manoeuvres during vena cava trombectomy.Material and Methods. The study included 78 (62.9%) men and 46 (37.1%) women. The average age of patients was 58.4±10.5 years. There were right-sided tumours in 82 (66.1%) cases and left-sided tumours in 42 (33.9%). Caval thrombi were of levels I, II, II, and IV, respectively, in 35 (28.2%), 36 (29%), 27 (21.8%) and 26 (21%) observations. All operations were performed without the use of artificial circulation. Results of the study. Liver mobilization was technically difficult in 17.8% of observations and was accompanied by 17 (37.8%) intraoperative complications in 13 (28.9%) patients. The most severe complications were injuries to the hepatic parenchyma (11.1%) and the main hepatic veins (11.1%). Access to the supra-diaphragmatic section of the LAA and the right atrium was feasible in all observations with an intraoperative complication rate of 8.8%. No damage to the right diaphragmatic nerve was noted in any of the observations. The right pleural cavity was opened in 2 (5.9%) patients with atrial thrombi. Another patient (2.9%) had damage to the posterior wall of the inferior vena cava at the level of its intrapericardial segment. Thrombus apex palpation and milking maneuver were successful in 83.1% and 90% of patients, respectively.Conclusion. Removal of tumour thrombi from the IVC for renal neoplasms is a complex surgical intervention. It requires the use of a large number of special surgical manoeuvres and techniques, which are difficult to perform in 10% of patients and may be accompanied by severe intraoperative complications.