FACTORS OF PERIOPERATIVE MORTALITY IN PATIENTS WITH GROWING RENAL CELL CARCINOMA IN INFERIOR VENA CAVA LUMEN

Difficult surgical cases of tumors of the inferior vena cava occur very often, because this intervention is characterized with technical difficulties and severe intraoperative complications. The most dangerous of these include massive bleeding, acute heart failure, and pulmonary embolism by tumor masses, which are the most common causes of perioperative mortality. Vena cava trombectomy is a special operation that can be accompanied by heavy bleeding at virtually any stage. The causes and frequency of mortality in 108 patients operated for renal cell carcinoma with growing to the inferior vena cava were retrospectively analyzed. Reliable factors for the prognosis of perioperative mortality in this pathology have been identified. Factors that characterize the tumor thrombus features, as well as parameters related to general condition of a patient, have been found to be of the greatest importance. The results of the study showed that the level of perioperative mortality in caval tumor thrombi is 8.3 % when using surgical methods without artificial circulation. The presented patient population contained a significant proportion of so−called "high" thrombi of III−IV levels, thrombi invading the wall of the inferior vena cava, as well as retrograde spread of intraluminal tumor. The main causes of death were acute heart failure, intraoperative bleeding, pulmonary embolism with tumor masses and acute renal failure. The prognostic value of perioperative mortality was demonstrated by the following thrombus factors: its "high" level, invasion of intraluminal tumor into the caval wall, signs of complete obstruction of caval blood flow. The mortality rate was objectively affected by severe heart failure, signs of pulmonary embolism before surgery. Key words: inferior vena cava, tumor thrombus, renal cell carcinoma, vena cava trombectomy, lethality.

Angiomyolipoma with Intraluminal Tumor Thrombus into the Inferior Vena Cava: Insights and Treatment Alternatives

Angiomyolipoma (AML) is a frequent benign renal tumor, corresponding to 0.3-3% of all renal masses. Eighty percent of AML occur sporadically; however, 10% have a hereditary component. We describe the case of a 41-year-old female patient with left abdominal pain associated with emesis, diarrheal stools, and dysuria. Upon admission, a computed tomography scan showed a left renal mass with tumor thrombus extending into the left renal vein and inferior vena cava (IVC). The patient underwent an open left radical nephrectomy plus thrombectomy. At 6months of follow-up, the patient is without tumor recurrence and asymptomatic.

An alternative method to detect peritoneal recurrence of gastric cancer: Clinical application of CT colonography.

19 Background: Peritoneal metastasis (PM) is among the most frequent patterns of recurrence of gastric cancer: however, it cannot be detected by general axial CT or even by PET until it develops to massive ascites or an overt peritoneal mass. CT colonography (CTC) is used to screen for colon cancer, with the advantage that it can provide both colonic and extracolonic information at the same time. Methods: CTC was applied for patients that were suspected to have PM based on their clinical symptoms and general CT findings, without sufficient information to confirm the diagnosis, to detect signs of peritoneal metastasis earlier. PM diagnosis in CTC was defined as the finding of an abnormal deformity of the colonic wall without intraluminal tumor by both the attending doctors and radiologists. Results: Twelve patients suspected of having PM were enrolled in the study. Nine of those patients (75%) were positive for PM by CTC. Abnormal colonic deformities were also identified in other locations other than the lesions detected by general CT in 6 patients. All of the nine patients with positive PM were clinically confirmed to have PM, and had a poorer prognosis (median survival: 252 days). The three patients with negative PM are all alive without recurrence. Conclusions: CTC is thus considered to be a candidate for the early detection of PM. Further study with more patients is therefore warranted.