Yulia Aleksandrovna Stepanova
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Aleksandr Anatolevich Gritskevch
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Amiran Shotaevich Revishvili
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Madina Valerevna Kadirova
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Egor Sergeyevich Malyshenko
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ntroduction. A distinctive feature of kidney cancer is a frequent, compared with other tumors, spread of the tumor through the venous collectors (in the renal and inferior vena cava up to the right atrium), along the path of least resistance to invasive growth.The aim of the study was to present a clinical case of radical treatment of kidney cancer involving extensive IVC thrombosis.Materials and methods. The study describes a clinical case of radical treatment of patient M. with kidney cancer involving extensive IVC thrombosis, extending to the right atrium (written informed consent for patient information and images to be published was obtained prior to the study). During preoperative examination, the patient was diagnosed with renal cell carcinoma with non-occlusive hypervascular tumor thrombus of the renal vein, the inferior vena cava and the right atrium based on the findings of ultrasound examination (transabdominal and transthoracic, and transesophageal), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Results and discussion. Surgical treatment remains the main method of treatment of renal cell cancer, moreover, the inferior vena cava thrombosis cannot serve as a cause for refusing surgical treatment. The thrombus spreading along the venous collectors is an important factor in determining the tactics of surgical treatment. The length of the tumor thrombus, as well as the degree of its fixation and ingrowth into the vein wall is of great significance for planning surgical techniques and predicting clinical outcomes. Based on various methods of radiological examination, patient M. was diagnosed with cancer of the right kidney, 3 stage T3cNxM0, IVC tumor thrombus, paraneoplastic syndrome (hyperthermia), right-sided nephrectomy with aortocaval lymphadenectomy, thrombectomy from the IVC, vascular isolation of the liver, resection of the IVC, thrombectomy from the right atrium combined with cardiopulmonary bypass.Conclusion. Despite the technical complexity of nephrectomy with thrombectomy from the IVC, especially in the presence of a massive supradiaphragmatic thrombus, these interventions have no alternatives if a radical treatment is to be achieved. Step-by-step support using radiological methods of investigation is an important aspect of patients preparation; this allowing determining the exact volume of the damage and non-invasively assessing clinical outcomes of surgical treatment.
The importance of intraoperative transoesophageal monitoring when operating on renal cancers that involve the right atrium
