Surgical treatment of inferior vena cava tumor thrombus.
Authors:   Department of Oncourology A.V. Vishnevsky National Medical Research Center of Surgery, Polotbek uulu Z. ,   Moscow, Russia, Сhevina A.A. ,   department of anesthesiology-resuscitation with resuscitation and intensive care ward of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia, Raguzina V.Yu. ,   radiology methods of diagnostics and treatment department of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia, Oganyan V.A. ,   Department of Oncourology A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia, Miroshkina I.V. ,   Department of Oncourology A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia, Karelskaya N.A. ,   Radiology department of A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia, Stepanova Y.A. ,   A.V. Vishnevsky National Medical Research Center of Surgery; Moscow, Russia, Kochetov A.G. ,   Urological Center of the National Medical research centre of high medical technoligies named after A.A.Vishnevsky of the Ministry of Defense of the Russian Federation; Moscow, Russia, Sapelkin S.V. ,   Vascular Surgery Department of the Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation; Moscow, Russia
Published: January 2023

Introduction. Venous invasion and tumor thrombus formation are rare, but life-threatening complications of renal cell carcinoma (RCC), especially in combination with metastases, are considered significant adverse prognostic factors. Aim. To systematize the existing knowledge and summarize the clinical experience of surgical treatment (open and robot-assisted surgery) of RCC with inferior vena cava (IVC) tumor thrombus. Materials and methods. A literature search in the period 2000-2022 was performed in core databases MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The PICO framework (Population-Intervention-Comparison-Outcome) was used to develop a literature search strategy. The following keywords were used to search databases: «renal cell carcinoma», «venous invasion», «inferior vena cava tumor thrombus», «surgical treatment», «robot-assisted», «clinical outcomes». Results. A total of 65 publications were identified. Various classifications of tumor thrombus level are considered, their inferiority and superiority in terms of selecting optimal surgical treatment, both open or robot-assisted surgeries, are discussed. Independent predictors of severe perioperative complications are determined. Optimal surgical treatment of RCC with tumor thrombus is highlighted. Functional and oncological outcomes of patients with RCC with IVC tumor thrombus, who underwent open surgical intervention and robot-assisted ones, are presented. Conclusion. Open surgery in patients with RCC and IVC tumor thrombus above the hepatic veins is associated with prolonged surgery duration, higher intraoperative blood loss, and prolonged in-hospital stay. Prolonged in-hospital stay, the need for blood transfusion, metastasis, sarcomatoid differentiation, and Clavien-Dindo grade 3-5 postoperative complications are predictors of poor outcomes.