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The inferior vena cava lesion in adrenocortical carcinoma: results of surgical treatment


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Objective. To analyze the results of surgical treatment of patients with lesions of the inferior vena cava (IVC) in adrenocortical cancer (ACC). Material and methods. From 1989 to 2015 191 patients with histologically proven ACC were treated at Russian Oncological Research Center. Among them, 37 (19.4%) patients had extension into IVC. IVC resection due to tumor invasion was performed in 11 cases: 10 cases of right-sided ACC with direct IVC invasion and 1 case of left adrenal cancer with IVC invasion by metastatic lymph nodes. IVC or renal vein thrombosis was detected in 26 patients. 4 patients with IVC invasion and 15 with thrombosis had distant metastases. 20 patients underwent thombectomy from IVC. Thrombus extended into the suprarenal level of the IVC in 6 cases, into hepatic level - in 6 cases, supradiaphragmatic - in 5 cases. All surgeries were performed without cardiopulmonary bypass. Thrombectomies were accompanied by various types of IVC resection, with or without prostethic replacement of the vein. Results. 5 patients died postoperatively. Median survival was 25 months after adrenalectomy with IVC resections, and 14 months after tumor thrombectomy. Conclusion. Our findings suggest that surgical treatment can be effective for management of adrenocortical cancer with extension into the inferior vena cava.

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