FIRST EXPERIENCE AND SUCCESSFUL SURGICAL TREATMENT OF LEFT KIDNEY CANCER WITH EXTENDED TUMOR VENOUS THROMBOSIS OF THE INFERIOR VENA CAVITY AND RIGHT ATRIUM [LEVEL IV] IN THE REPUBLIC OF KAZAKHSTAN

Abstract

Introduction: In Kazakhstan, more than 1,600 cases of malignant renal neoplasms are diagnosed annually, and the mortality rate is more than 300 cases. A characteristic feature of kidney cancer is the formation of tumor thrombosis of the inferior vena cava (observed with a frequency of up to 25%), in some cases extending to the right atrium. In the case of extended thrombosis of the inferior vena cava, the problem of effective treatment of this pathology is especially relevant. Objective of the study: To describe a clinical case of successful surgical treatment of renal cell carcinoma of the left kidney, complicated by tumor thrombosis of the inferior vena cava and right atrium (type IV), which was performed for the first time in the Republic of Kazakhstan. Clinical case: A 56-year-old man was hospitalized in the Department of General and Thoracic Surgery of JSC "NSMC" with a diagnosis of "left kidney cancer" (cT3cN0M0, St III), complicated by tumor thrombosis of the inferior vena cava to the tricuspid valve in the right atrium (IV type of invasion) and a large tumor in the left kidney. The patient underwent a planned operation as follows: sternolaparotomy, radical nephrectomy on the left with thrombectomy from the inferior vena cava and right atrium, aortocaval lymph node dissection under artificial circulation. Blood loss was 2000 ml. There was no liver ischemia. The total duration of the operation was 525 minutes. The postoperative period was uneventful, without complications. The patient was discharged from the hospital on the 12th day after the operation. Conclusions: Surgical access for tumor invasions of the inferior vena cava (especially types III-IV) must be convenient and adequate, creating convenient access to both the right atrium and the inferior vena cava itself along its entire length. In case of tumor invasion of the inferior vena cava orifice and the right atrium, the use of a heart-lung apparatus with blood flow contour through a cardiotomy reservoir by coronary suction makes thrombectomy safe against hemorrhagic complications. However, indications for the use of such a procedure – e.g., options for connecting the heart-lung machine, the level of hypothermia – require clarification.