Removal of the Tumor Thrombus from the Right Atrium without Extracorporeal Circulation: Emphasis on the Displacement of the Tumor Apex.

OBJECTIVES: To assess the outcomes of cavoatrial tumor thrombus removal using the liver transplantation technique for thrombectomy, a retrospective study was conducted. MATERIALS AND METHODS: Five patients with atrial tumor thrombi who underwent piggy-back mobilization of the liver, surgical access to the right atrium from the abdominal cavity, and external manual repositioning of the thrombus apex below the diaphragm (milking maneuver) were included into the study. Extracorporeal circulation was used in none of the cases. The average length of the atrial component of the tumor was 20.0 ± 11.7 mm (10 to 35 mm), and the width was 14.8 ± 8.5 mm (10 to 30 mm). In this work, the features of patients and surgical interventions as well as perioperative complications and mortality were analyzed. RESULTS: External manual repositioning of the tumor thrombus apex below the diaphragm was successfully performed in all patients. Tumor thrombi with the length of the atrial part up to 1.5 cm were removed through the extrapericardial approach. For evacuation of the thrombi with the large atrial part (3.0 cm or more), a transpericardial surgical approach was required. Specific complications associated with the access to the right atrium from the abdominal cavity (paresis of the right phrenic nerve, pneumothorax, and mediastinitis) were not detected in any case. The average clamping time of the supradiaphragmatic inferior vena cava (IVC) was 6.3 ± 4.6 min. The volume of intraoperative blood loss varied from 2500 to 5600 ml (an average of 3675 ± 1398.5 ml). CONCLUSION: Our work represents the initial experience in the liver transplantation technique for thrombectomy in distinct and well-selected patients with atrial tumor thrombi. The effectiveness of this approach needs further study. The video presentation of our research took place in March 2019 at the 34th Annual EAU Congress in Barcelona.

[COMPLICATIONS OF SURGICAL TREATMENT OF A RENAL­CELL CANCER WITH INTRAVENOUS SPREADING].

Retrospective investigation, conducted for estimation of perioperative complications, while performing surgical treatment of a renal­cell cancer with tumoral thrombi, was presented. In 132 patients the tumoral thrombi spreading is restricted by renal vein and by vena cava inferior (VCI) as well. The patients were operated on, using the "chevron" access in the absence of artificial blood circulation. Perioperative complications rate in the patients in presence of macroscopic tumoral thrombi constitute 56.8%, while tumoral spreading into VCI ­ is trustworthy bigger (р<0.05). Presence of cardiac insufficiency, tumoral invasion of the VCI wall, retrograde spreading of thrombus with the VCI concurrent blood thrombosis, аs well as presence of the indices in accordance to the ECOG scale more than 1 point have constituted unfavorable factors.

[SURGICAL TECHNIQUE OF A RENAL ARTERY CONTROL WHILE REMOVAL OF TUMORAL THROMBI FROM VENA CAVA INFERIOR].

Efficacy and safety of a renal artery ligation after thrombectomy in comparison with those while using a standard surgical technique were studied. Possibility of performance and safety of thrombectomy without preliminary ligation of renal artery was proved. The results did not depend on level of intravenous tumoral spread and were significantly better, than while application of standard approaches to renal artery because of absence of embolic complications.

[ABDOMINAL TRANSDIAPHRAGMATIC EXTRAPERICARDIAL SURGICAL ACCESS TO SUPRADIAPHRAGMATIC PART OF VENA CAVA INFERIOR IN PATIENTS OPERATED FOR RENAL-CELL CANCER].

Safety and possibility to perform abdominal surgical accesses to supradiaphragmatic part of vena cava inferior (VCI) in patients, operated on for renal-cell cancer, were estimated. In 12 patients the results of application of several surgical access variants to supradiaphragmatic part of VCI were estimated. Most simple and safe way to isolate supradiaphragmatic VCI and cavaatrial junction is to perform a T-like diaphragmotomy. Intraoperative complications rate have constituted 36.4%. The blood loss volume due to VCI injury (in 3 cases) while performing transdiaphragmatic surgical access to supradiaphragmatic part of VCI, have constituted 112.5 ml at average. Injuries of pleura, pericardium, main truncus of diaphragmatic nerve did not occur.

[Cryodestruction of the anterior lobe of adenohypophysis in terminal patients with prostatic cancer]. / Kriovozdeistvie na peredniuiu doliu adenogipofiza v lechenii terminal'nykh bol'nykh rakom prestatel'noi zhelezy.

The authors used a new method of treatment of prostatic cancer--selective stereotactic puncture cryodestruction of the anteriod hypophysis lobe--which prevents water-electrolyte imbalance, relieves pain syndrome due to bone metastases, reduces androgenic stimulation of the prostate, improves quality of life for patients of clinical group IV. The operation is low-traumatic and is not accompanied with serious complications.