Complete response of renal cell carcinoma vena cava tumor thrombus to neoadjuvant immunotherapy

Inferior vena cava (IVC) tumor thrombus in renal cell carcinoma is a rare entity that suggests heightened biologic behavior and a surgical challenge during the course of treatment. Tumor thrombus can extend from the renal vein to the right atrium. This cephalad extension is classified by four different levels. These levels determine which surgical approach is used, whether a thoracoabdominal incision is needed, and whether a patient needs to be placed in circulatory arrest. Complete surgical resection of the tumor is potentially the only curative treatment, although it supposes a challenge because of operative difficulty and the potential for massive bleeding or tumor pulmonary thromboembolism. IVC tumor thrombus presents with a few differentials that need to be assessed, including bland thrombus, primary IVC leiomyosarcoma, hepatocellular carcinoma, adrenal cortical carcinoma, primary lung carcinoma, and Wilms tumor. The importance of diagnosing IVC tumor thrombus secondary to renal cell carcinoma is demonstrated as well as a sonographic protocol for assessing IVC tumor thrombus.

Download Full-text

Role of presurgical targeted molecular therapy in renal cell carcinoma with an inferior vena cava tumor thrombus

OncoTargets and Therapy ◽

10.2147/ott.s158114 ◽

2018 ◽

Vol Volume 11 ◽

pp. 1997-2005 ◽

Cited By ~ 2

Author(s):

Cheng Peng ◽

Liangyou Gu ◽

Lei Wang ◽

Qingbo Huang ◽

Baojun Wang ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Inferior Vena Cava ◽

Cell Carcinoma ◽

Renal Cell ◽

Tumor Thrombus ◽

Inferior Vena ◽

Vena Cava ◽

Molecular Therapy ◽

Targeted Molecular Therapy

Download Full-text

Single Stage Resection of Renal Cell Carcinoma with Right Atrial Extension– A Case Report

Journal of Bangladesh College of Physicians and Surgeons ◽

10.3329/jbcps.v36i2.36070 ◽

2018 ◽

Vol 36 (2) ◽

pp. 77-79

Author(s):

Syed Al Nahian ◽

Sonjoy Biswas ◽

Rezaul Hassan ◽

M Zahid Hasan

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Right Atrium ◽

Primary Tumor ◽

Renal Cell ◽

Renal Vein ◽

Tumor Thrombus ◽

Vena Cava ◽

Single Stage ◽

Right Atrial

Renal cell carcinoma (RCC) is the commonest primary tumor of the kidney which may invade through the renal vein into the inferior vena cava (IVC), and then it can extend intraluminally with subsequent tumor-thrombus formation. Here we report a case involving excision of a primary RCC with tumor-thrombus involving IVC up to right atrium with the use of extracorporeal circulation. Single stage surgical procedure was performed in collaboration with a urological team aiming complete resection of primary tumor, para-aortic lymphadenectomy and removal of IVC thrombus extending to right atrium with the help of cardiopulmonary bypass. After arresting heart, RA was opened and the mass was removed through RA from IVC and hepatic vein level. Abdominal IVC was opened and the entire residual mass was removed from below also small amount of thrombus removed from left renal vein. Postoperative venous doppler showed no residual thrombus in venous system. Histopathology report confirmed papillary renal cell carcinoma. The patient was discharged from hospital in the 12th post-operative day without any complication.J Bangladesh Coll Phys Surg 2018; 36(2): 77-79

Download Full-text