Volume 24, Issue 106, November - December, 2020

Renal cell carcinoma with tumour thrombus adherent to inferior vena caval wall: A case report

Niveditha S^1♦, Abhijit Dhale², Meenakshi Yeola³

¹Resident, Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
²Assistant Professor, Department of General Surgery & Urosurgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
³Professor & HOD, Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India

^♦Corresponding author
Resident, Department of General Surgery, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: devu.devoos@gmail.com

ABSTRACT

To report a case of left renal cell carcinoma with tumour thrombus is extending into inferior vena caval wall. Case report: A 56 year old female patient presented with left flank pain and painless hematuria of 1 month duration. Clinical examination revealed a bimanually palpable lump in left lumbar region. Further investigation with CECT abdomen & pelvis revealed a mass arising from left kidney with tumour thrombus extending into IVC (Level III). The patient underwent preoperative angioembolization of left renal artery followed by left radical nephrectomy with IV cavotomy and tumour thrombus removal. However intraoperatively it was found that the tumour thrombus was not just abutting the wall of IVC instead it was adherent to the IVC wall making its removal difficult & hence gradual peeling of thrombus was done with cardiopulmonary bypass and hypothermic cardiac arrest which in turn lead to severe blood loss and prolonged surgical time. This case is considered important because a multidisciplinary approach with CPB helped us in overcoming an unexpected intraoperative complication and successful completion of the surgery. Moreover this case also emphasizes on the fact that radiological investigations can underestimate the difficulty in surgery and being prepared with CPB standby is necessary before attempting such a case.

Keywords: Renal cell carcinoma; venous tumour thrombus; IVC wall invasion

Medical Science, 2020, 24(106), 4014-4018

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