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 Table of Contents  
CLINICAL IMAGE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 177-179

Successful resection of an advanced renal carcinoma by a multidisciplinary team consisting of a urologist, liver transplant and cardiac surgeons


1 Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, India
3 Department of Urology, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission13-Jun-2022
Date of Decision20-Jun-2022
Date of Acceptance02-Jul-2022
Date of Web Publication29-Aug-2022

Correspondence Address:
Dr. Bhabani Sankar Sahoo
Department of Surgical Gastroenterology, HPB Surgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_71_22

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How to cite this article:
Sahoo BS, Mehta NN, Shivnani G, Khanna S, Nundy S. Successful resection of an advanced renal carcinoma by a multidisciplinary team consisting of a urologist, liver transplant and cardiac surgeons. J Med Evid 2022;3:177-9

How to cite this URL:
Sahoo BS, Mehta NN, Shivnani G, Khanna S, Nundy S. Successful resection of an advanced renal carcinoma by a multidisciplinary team consisting of a urologist, liver transplant and cardiac surgeons. J Med Evid [serial online] 2022 [cited 2022 Oct 5];3:177-9. Available from: http://www.journaljme.org/text.asp?2022/3/2/177/354987




  Introduction Top


Tumour thrombus migration into the inferior vena cava (IVC) is a unique aspect of renal cell carcinoma, with an incidence of 4%–10%.[1],[2] In 2%–16% of patients from this group, the thrombus extends further into the right atrium.[3] According to tradition, caval thrombus extension is classified as being at the level 4 stage[2] and carries a poor prognosis. However, if excised, there are reports of a 25%–57% 5-year disease-free survival in such patients.[4] A multidisciplinary team approach and considerable surgical expertise are required to resect such advanced lesions. We present herein our experience with such a case.


  Summary Top


A male patient in his 7th decade, presented with abdominal pain for 2 months. Cross-sectional imaging showed a 7 cm × 8 cm × 7.5 cm mass in the mid and upper pole of the left kidney with a tumour thrombus extension into the inferior cava and right atrial junction [Figure 1]. The tumour thrombus also extended into the right hepatic vein [Figure 2].
Figure 1: Thrombus extension up to confluence and right atrium (arrow)

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Figure 2: Tumour thrombus involving the RHV (arrow). RHV: Right hepatic vein

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After discussion in a multidisciplinary team meeting, he was taken up for surgery. Through a long Mercedes-Benz incision, the infrarenal IVC and left renal vein were looped. Liver mobilisation was done to achieve access to the suprahepatic cava. Once the abdominal dissection was complete, a thoracotomy was performed, and the patient was put on cardio-pulmonary bypass, under the support of which an opening was made in the infrarenal IVC to evacuate the thrombus. A left radical nephrectomy was performed and the right atrium was also opened simultaneously, and all the tumour thrombus, including the thrombus in the right hepatic vein, was removed. The patient was then taken off the cardiopulmonary bypass with slow rewarming [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]. Subsequently, he was monitored in the cardiac intensive care unit for 2 days and discharged on POD 7.
Figure 3: Dilated suprahepatic IVC (arrow). IVC: Inferior vena cava

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Figure 4: Left renal vein with tumour thrombus looped (arrow)

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Figure 5: Tumour thrombus removed from the IVC through the left renal vein stump (arrow). IVC: Inferior vena cava

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Figure 6: Tumour thrombus was seen in the right atrium (arrow)

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Figure 7: Removed thrombus

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4

Large and advanced renal carcinomas which extend into the IVC and right atrium may be successfully excised after careful preparation and cooperation between urologists, liver transplant and cardiac surgeons and provide such patients with reported 5-year disease-free survival rates of up to 57%.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ciancio G, Soloway M. Resection of the abdominal inferior vena cava for complicated renal cell carcinoma with tumour thrombus. BJU Int 2005;96:815-8.  Back to cited text no. 1
    
2.
Mootha RK, Butler R, Laucirica R, Scardino PT, Lerner SP. Renal cell carcinoma with an infrarenal vena caval tumor thrombus. Urology 1999;54:561.  Back to cited text no. 2
    
3.
Nesbitt JC, Soltero ER, Dinney CP, Walsh GL, Schrump DS, Swanson DA, et al. Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus. Ann Thorac Surg 1997;63:1592-600.  Back to cited text no. 3
    
4.
Zisman A, Wieder JA, Pantuck AJ, Chao DH, Dorey F, Said JW, et al. Renal cell carcinoma with tumor thrombus extension: Biology, role of nephrectomy and response to immunotherapy. J Urol 2003;169:909-16.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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