SURGICAL EXPERIENCE OF 3 CASES OF RENAL CANCER COMBINED WITH TUMOR THROMBUS IN THE INFERIOR VENA CAVA

Abstract

We operated on three cases of renal cancer combined with tumor thrombus in the inferior vena cava (NC). In 2 cases of infrahepatic type (case 1 and 3), tumor thrombi were excised with a part of vena caval wall under partial or total clamping of IVC. The defect of IVC wall was closed with primary suture in one case and with a EPTFE patch in other case. In case 1, renal tumor was left unresected, however, she survived for 15 months. In case 3, left lung and kidney had been resected because of primary lung cancer and its metastasis. He survived immediately after right nephrectomy under hemodialysis, however, he suffered from pneumonia of residual lung 3 weeks after operation and died of RDS. In a case of suprahepatic type (case 2), thrombectomy was carried out under cardiopulmonary bypass. The patient is alive and well and there is no evidence of cancer cell dissemination due to extracorporeal circulation 16 months postoperatively. In conclusion, combined thrombectomy of IVC should be carried out aggressively in order to increase the probability of curative operation and avoid sudden death due to pulmonary embolism or IVC syndrome in renal cancer. In suprahepatic type, thrombectomy is safely performed by the support of cardiopulmonary bypass.