Authors
Shailendra Shuklaa, S Vasudevana, VR Rajasekharanb
aDepartment of Urology, Medical College, Trivandrum; bDepartment of Thoracic Surgery, Medical College, Trivandrum
Abstract
Background: Renal cell carcinoma (RCC) frequently presents with venous tumor thrombus, posing significant management challenges. Despite surgical resection being the primary therapeutic option, it is associated with high risks and varied outcomes, largely due to the insidious nature of the disease leading to late-stage diagnoses.
Case Report: We report the case of a 57-year-old male with a background of hypertension, diabetes mellitus, and chronic obstructive pulmonary disease, presenting with symptoms including fever, hematuria, and weight loss. Diagnostic imaging confirmed a substantial left renal mass with extensive tumor thrombus extending into the inferior venecava and hepatic vein. He underwent a complex radical nephrectomy and venacaval thrombectomy, necessitating cardiopulmonary bypass. Postoperatively, the patient developed renal dysfunction and deep vein thrombosis. Histopathology confirmed Grade 2 clear cell RCC. The patient succumbed to cardiac complications 8 months post-surgery.
Discussion: Surgical resection of the entire tumor burden offers the only potential cure for RCC with venous thrombus, despite its technical difficulties. Magnetic Resonance Imaging (MRI) is essential for accurate staging. The management of high-level thrombi (Levels 3 and 4) often requires a multidisciplinary approach involving cardiothoracic surgeons and cardiopulmonary bypass, which inherently increases perioperative risks. Patient survival rates are significantly influenced by disease stage and metastatic spread.
Conclusion: Comprehensive surgical intervention remains the cornerstone of treatment for RCC with venous thrombus. Although technically demanding, it provides the most promising chance for durable survival in patients without metastatic disease, with outcomes affected by surgical complexity and patient comorbidities.