Nephroureterectomy with inferior vena-caval thrombectomy in post-chemotherapy Wilms' tumour in a child – From the eyes of the surgeon!

Abstract

Intracaval extension is present in 4-11% of all Wilms' tumour (WT). We present the open surgical nuances of inferior vena cava (IVC) thrombectomy with nephroureterectomy in post-chemotherapy WT. A 10-year-old girl with right WT and intracaval tumour thrombus presented for surgical resection after six cycles of chemotherapy (vincristine, actinomycin D). A preoperative assessment plan of the vascular anatomy of the tumour was done. Meticulous intraoperative handling of the tumour mass, overcoming chemotherapy-induced fibrosis during inter-aortocaval groove dissection, optimal hemodynamic control during venotomy, en bloc resection of tumour with intracaval thrombus, and repair of the IVC are detailed. A 70×65×30mm right renal mass with 20×10×4mm level II IVC thrombus was excised en bloc. The intraoperative blood loss was 250mL, operative time was 220min, and total hospital stay was 7 days. The child completed post-surgical chemotherapy as per protocol. There is a paucity of literature regarding techniques for resection of WT with IVC extension in post-chemotherapy patients. With erudite preoperative planning and fine intraoperative dissection, complete resection of WT with intracaval thrombus is feasible with minimal blood loss and rapid postoperative recovery.