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Órgano Oficial de el Colegio Mexicano de Urología

2007, Number 1

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Bol Col Mex Urol 2007; 22 (1)

Abordaje toracoabdominal en carcinoma renal de células claras con trombo en vena cava supradiafragmático. Reporte de un caso

Neri PE, Chavarría MJJ, Errejón DA

Language: Spanish
References: 36
Page: 42-46
PDF size: 321.95 Kb.


ABSTRACT

Introduction: Renal cell carcinoma is responsible for 3% of all malignant processes in the adults. A singular characteristic is the commitment of venous system that generally is pronounced in tumoral thrombus form within renal or inferior cava vein present in near 4 to 15% of the cases. Thoraco-abdominal access for surgical removal of the kidney along with tumoral thrombus is a recommended treatment modality to facilitate the surgical exhibition. A singular characteristic is the commitment of venous system that generally is pronounced in tumoral thrombus form within renal or inferior cava vein present in near 4 to 15% of the cases. We present the case: of a patient with renal cells carcinoma with superior cava vein thrombus that was treated in multidisciplinary form. Left radical nephrectomy was made in addition to thrombectomy by means of thoraco-abdominal mid incision and support of extracorporeal circulation pump, with a surgical time of 8 hours, transoperatory bleeding of 1,200 cc, needing transfusion of two globular packages and support of four days in coronary cares, withdrawing from the hospital seven days postsurgery. Hystopathologic report was clear cells renal carcinoma with invasion to renal capsule, renal vein wall with tumoral infiltration, three lymphatic ganglia with tumoral activity. Left suprarrenal gland free of tumor (pT4 N2 M0 EC IV). To seven months of the surgery the patient is with ECOG 0 and without evidence of tumoral activity. The boarding is individualized according to the surgeon’s experience, exhibition and favorable vascular control. Thoraco-abdominal access has favored proximal control and exhibition of thrombus in level 3. The mid sternotomy with early control of the inferior intrapericardial cava vein has been recommended in thrombus of level 3 as well as the utility of cardiopulmonary bypass. Conclusions: Considered three years survival is 71%, free disease period 42%, mortality 22% in patients without synchronous metastasis evidence demonstrates that the affectation of renal or inferior cava vein alone, in absence of ganglionary metastasis or at a distance it does not affect of adverse form the prognostic.


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