The dissertation is dedicated to the problems of surgical treatment of patients with renal cell carcinoma (RCC) with invasion into the inferior vena cava (IVC) and right atrium and improvement of surgical strategy. The aim of the study was identified in order to solve these problems as follows: to improve the results of treatment of patients with RCC with invasion into the IVC and right atrium by justifying the optimal approaches of surgical tactics, improving the methods of prevention of thromboembolic and hemorrhagic complications. According to the aim the objectives of research are defined: to study the peculiarities of RCC clinical course depending on the level of IVC tumor thrombosis, to analyze the correlation between the frequency of postoperative complications and the tumor venous thrombus level in patients with RCC, to study the peculiarities of surgical prevention of venous thromboembolic complications in patients with RCC complicated by invasion into the IVC and right atrium, to determine the role of intraoperative blood reinfusion in the aspect of oncological safety in patients with RCC complicated by invasion into the IVC and right atrium, to establish a correlation between the tumor venous thrombus level and the presence of regional and distant metastases, to evaluate the long-term results of surgical treatment of patients with RCC complicated by tumor venous invasion. The study was based on comprehensive clinical, laboratory and instrumental examination, retrospective and prospective analysis of the immediate and long-term results of surgical treatment of 88 patients with RCC, complicated by tumor venous thrombosis, who were hospitalized to the Vascular surgery and Transplantation department of communal noncommercial enterprise of Lviv regional counsil «Lviv regional clinical hospital» for the period from 1993 to 2019 years. For a comparative analysis all patients were divided into two groups. The first, main, group included 62 patients with RCC, complicated by tumor thrombosis of the IVC and right atrium, which in 59 cases underwent radical nephrectomy with thrombectomy from IVC and right atrium, and three patients, who had previously undergone nephrectomy for RCC, due to recurrence of the disease, underwent tumor removal and thrombectomy from the IVC and right atrium. The second, control, group included 26 patients with RCC and renal vein invasion, who underwent radical nephrectomy. The results of a scientific search made it possible to supplement the clinical knowledge of the symptoms of RCC, complicated by IVC and right atrium tumor thrombosis. In particular, a significant difference between the incidence of iliofemoral deep vein thrombosis due to increasing of IVC tumor thrombus level was established (p<0,05). The use of combined mini-invasive approaches in the surgical treatment of supradiaphragmatic level of intracaval invasion due to RCC is proposed, which will reduce the volume, trauma and duration of surgery, as well as provide reliable pulmonary embolism prevention. The role of intraoperative blood reinfusion in the aspect of oncological safety in patients with RCC, complicated by invasion of IVC and right atrium, was first determined. Based on the results of cytological examination of tumor contamination of blood sediment material from the operating field during the cavatomy and washed autoerythrocytes it has been established that intraoperative reinfusion can provide the necessary ablastics and doesn’t pose an additional risk of tumor dissemination during radical nephrectomy and IVC thrombectomy. For the first time in patients with RCC, complicated by tumor thrombosis of IVC and right atrium, the optimal scheme of anticoagulant therapy in the postoperative period was improved. For the first time in Ukraine the long-term results of surgical treatment of patients with RCC, complicated by invasion of IVC and right atrium, during the last three decades were analyzed.
