OBJECTIVE

To analyze the long-term postoperative outcomes and survival in patients with kidney cancer complicated by thrombosis of renal vein and inferior vena cava.

MATERIAL AND METHODS

We analyzed the outcomes in 22 patients (16 men and 6 women) with kidney cancer stage III-IV complicated by thrombosis of renal vein and inferior vena cava. The Mayo Clinic thrombus classification was used to divide the patients depending on inferior vena cava invasion. In 30% of patients, the tumor spread to hepatic and supraphrenic segments of inferior vena cava. In 86% of cases, right kidney cancer complicated by inferior vena cava invasion was diagnosed. Cancer stage IV was confirmed in 40% of patients. Removal of thrombus from inferior vena cava was followed by repair or replacement of this vein, nephradrenalectomy and aortocaval lymph node dissection. Neoadjuvant therapy was not applied.

RESULTS

Clear cell renal cell carcinoma prevailed (81.8%). Adjuvant therapy was administered in 54.5% of patients. Maximum postoperative follow-up was 10 years. Kaplan—Meier disease-free survival and overall survival were analyzed. Median disease-free survival was 26.7 months, median survival in case of progression — 7.1 months.

CONCLUSION

Total and cytoreductive nephrectomy combined with reconstruction of inferior vena cava and modern adjuvant therapy can prolong the patient’s life even in case of distant metastases.