Abstract
Renal cell carcinoma (RCC) is the most common malignant tumor of the kidney. It is associated with inferior vena caval (IVC) extension in 4–10% of the patients. The Neves and Zincke classification of RCC tumors is based on their extension into the IVC, in which level I tumors extend renally, level II extend infrahepatically, level III extend retrohepatically, and level IV extend atrially. Although intravascular growth associated with RCC has no impact on survival when the tumors are treated surgically, the level and extension of the IVC tumor determines the surgical management plan. Transesophageal echocardiography (TEE) is used intraoperatively during resection of RCC in patients with level IV tumors because the tumor can embolize during surgical manipulation. In this case report, we present a case of a 50-year-old woman who was undergoing a radical nephrectomy a tumor thrombectomy to remove an RCC that was extending into the IVC and right atrium (RA). The surgery was complicated by embolization of the tumor to the pulmonary circulation intraoperatively. TEE enabled detection of tumor embolization few minutes before hemodynamic instability developed, this allowed faster management and contributed to a favorable patient outcome. We recommend continual TEE monitoring for all patients undergoing resection of RCC extending into the IVC and RA. This would help with earlier detection and management of complications, which will probably contribute to a decrease in the morbidity and mortality associated with the management of those high-risk patients.
Published Version
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