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.
Review purpose: to study the occurrence predictors of postoperative atrial fibrillation (PAF), effective predicting and treating methods according to global literature.Currently, PAF is considered one of the most frequent events among all cardiovascular complications as it develops in 30–65% of cases in patients after heart surgery. In recent decades, the PAF incidence has steadily increased despite advances in surgery and anesthesiology. PAF is a significant complication that affects the course of the postoperative period and requires special attention, since it leads to a longer hospital stay, increased treatment costs and can also lead to lethal outcomes in patients in this category. Considering PAF consequences, many studies have been performed to identify factors associated with the atrial fibrillation pathophysiology, to develop preventive measures aimed at treating high risk patients and minimize the side effects of antiarrhythmic drugs. The review and analysis of the global literature on the PAF causes, prevention and treatment are presented.
An organ-sparing approach is preferable at the treatment of patients with cancer of a solitary kidney, but doesn't always comply with the oncological radicalism. The technique of extracorporeal renal resection followed by autologous transplantation was developed to preserve renal function in patients with obligatory indications for organpreserving treatment. The aim is to evaluate the possibilities of ultrasound (US) at the stages of extracorporeal resection of a single kidney in the treatment of renal cell carcinoma. Materials and methods. The study included 22 patients treated with renal cell carcinoma of a single kidney in 2013-21 (average age 60.45±7 years). Men prevailed (73%). Multiple primary metachronous cancer occurred in 16 (73%) cases, multiple primary synchronous cancer -in 2 (9%), previous nephrureterectomy was performed in connection with benign kidney diseases (primary contracted kidney, hydronephrosis) -in 2 (10%), a congenital single kidney was in 2 (10%) patients. Previously underwent surgery on a single kidney for a malignant neoplasm of the same etiology for which 6 (27%) patients are being treated in this hospitalization. All the patients underwent US examination in B-mode and duplex scanning at the pre-/intra-and postoperative stage. If necessary, echo-contrast US (Sonovue) was performed intraoperatively and in the early postoperative period. Also, all patients underwent preoperative contrast-enhanced multidetected computed tomography (MDCT). MRI was performed in 7 cases. All the patients were operated with histological verification. Results. Staging according to the TNM system: pT1a-T3vN0-2M0-1G1-3, of which the tumor size exceeded 7 cm in 10 (50%) patients, distant metastases were in 8 (40%) cases. Reno-caval tumor thrombus was detected in 3 patients. Intraoperative US was performed at the stages of surgery: navigation to the stage of resection and assessment of the restoration of blood supply in the intervention area after kidney resection and wound closure. In 3 cases, extracorporeal renal resection was performed simultaneously with thrombectomy and resection of the inferior vena cava for renocaval tumor thrombus. In 4 cases, renal vessel replacement was performed. The tumor involved vessels in 3 cases and in 1 IOUS after resection showed thrombosis of the renal artery, which eventually required prosthetics. There were no intraoperative complications. All patients underwent US-monitoring on the 1st, 3rd and 5th days after surgery, more often and further as needed. The follow-up period (US, MSCT) was 19-85 months (53.3±17.2). Tumor progression occurred in 3 (15%) cases. One patient died due to the progression of the tumor process 20 months after the operation. Conclusion. US make it possible to control all the stages of extracorporeal resection of a single kidney under pharmacocold anti-ischemic protection with orthotopic replantation of renal vessels. The results of this surgical intervention are satisfactory, which indicates the advisability of further development of organ-saving treatm...
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