|Year : 2022 | Volume
| 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
Bhabani Sankar Sahoo1, Naimish N Mehta1, Ganesh Shivnani2, Sudhir Khanna3, Samiran Nundy1
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 Submission||13-Jun-2022|
|Date of Decision||20-Jun-2022|
|Date of Acceptance||02-Jul-2022|
|Date of Web Publication||29-Aug-2022|
Dr. Bhabani Sankar Sahoo
Department of Surgical Gastroenterology, HPB Surgery and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
|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|| |
Tumour thrombus migration into the inferior vena cava (IVC) is a unique aspect of renal cell carcinoma, with an incidence of 4%–10%., In 2%–16% of patients from this group, the thrombus extends further into the right atrium. According to tradition, caval thrombus extension is classified as being at the level 4 stage and carries a poor prognosis. However, if excised, there are reports of a 25%–57% 5-year disease-free survival in such patients. 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|| |
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 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 5: Tumour thrombus removed from the IVC through the left renal vein stump (arrow). IVC: Inferior vena cava|
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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%.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Mootha RK, Butler R, Laucirica R, Scardino PT, Lerner SP. Renal cell carcinoma with an infrarenal vena caval tumor thrombus. Urology 1999;54:561.
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.
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.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]