RCC and IVC Thrombectomy

Siros JitpraphaiThailand Speaker RCC and IVC ThrombectomyRCC and IVC thrombus Siros Jitpraphai Division of Urology, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, THAILAND Abstract Renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus represents a complex surgical challenge, with an incidence of venous involvement in 4-10% of cases. This case report demonstrates the successful surgical management of a 58-year-old female patient with a large left-sided renal mass and IVC thrombus. The patient presented with gross hematuria and was diagnosed with a 10 cm clear cell renal cell carcinoma (Fuhrman nuclear grade 3) extending into the renal vein and IVC. Recognizing the complexity of the case, a multidisciplinary approach was employed, involving urological and hepatobiliary surgical teams. The comprehensive treatment strategy included an open radical nephrectomy with IVC thrombectomy. The surgical technique was meticulously planned and executed, with several key considerations. Preoperative imaging was crucial in determining the exact level of thrombus, allowing for precise surgical planning. The procedure emphasized careful vascular control and en-bloc tumor removal, with intraoperative ultrasound used to ensure accurate thrombus localization. Surgical teams worked collaboratively to minimize potential complications and maximize surgical success. Operatively, the procedure was substantial, with an estimated blood loss of 900 mL and a total operative time of 5 hours. The patient required two days of postoperative intensive care and was discharged from the hospital seven days after the surgery. Pathological examination confirmed the diagnosis of clear cell renal cell carcinoma, with no lymph node metastasis detected and positive tumor thrombus. Importantly, surgical margins were found to be free of tumor. Follow-up evaluations have been encouraging, with no signs of tumor recurrence observed during regular intervals. This case illustrates the critical importance of a systematic surgical approach, precise technical execution, and comprehensive multidisciplinary management in successfully treating RCC with IVC thrombus. It provides valuable insights into the complex surgical management of this challenging condition, potentially offering guidance for similar cases in the future. Keyword: RCC (Renal Cell Carcinoma), IVC Thrombus, Thrombectomy, Surgical Technique, Multidisciplinary Management Highlight: RCC with IVC thrombus is a complex surgical challenge affecting 4-10% of cases. Successful management requires meticulous preoperative imaging, multidisciplinary team approach, and precise surgical technique. With careful planning and execution, 45-70% of patients can be cured through radical nephrectomy and IVC thrombectomy. Robotic Partial Nephrectomy in Complex and Difficult Tumor Location