The ways to reduce the intraoperative blood loss in renal cell carcinoma in patients with vena cava invasion

Vena cava invasion carries a high risk for development of life-threatening complications during renal cancer surgery, mainly that of bleeding (24.0%). We analyze the evidence related to the causes and sources of the intraoperative blood loss and technical approaches for the minimization of the bleeding. During the nephrectomy stage it is recommended to avoid the traumatization of the dilated collateral veins and to ligate the renal vein early in the course of the intervention. Renal vein embolization before the renal dissection could be the reasonable alternative. We show the main variants of vascular isolation at different levels of thrombectomy and emphasize the importance of the vena cava inferior branches variability (lumbar, hepatic, diaphragmal, etc.) and their proper control. Concerning this we depict the main technical maneuvers for mobilization of supradiaphragmal and intrapericardial parts of inferior caval vein. Further studies to surgical anatomy of the vena cava inferior and its branches is a main factor for reduction of the perioperative complications.