V5-10: RIGHT RADICAL NEPHRECTOMY WITH DISSECTION OF THROMBUS IN THE INFERIOR VENA CAVA LEVEL III
The renal cell carcinoma has a known tendency to spread forming tumor thrombus to the renal vein or inferior vena cava (4-10%)_x000D_ The level that reach the tumor, it’s in direct relation with the 5-years survival
We show a case of a male 58 years old patient with history of diabetes and smoking._x000D_ The patient complains of hematuria that started ten months ago._x000D_ In the general lab work, the patient was anemic with a hemoglobin of 8 gr/dL and a serum creatinine of 1.1 mg/mL._x000D_ The CT-Scan showed an 18 cm right kidney tumor with a thrombus in the inferior vena cava up to the diaphragm (Level III) with no seen metastatic disease or malignant lymphnodes _x000D_ Anterior open nephrectomy was performed, followed by control of inferior vena cava which it’s open entirely to perform the thrombectomy.
The estimated operative time was 260 minutes, with a bleeding of 1600ml, requiring 3 units of blood during the surgery. No complications was reported._x000D_ The post-op management was in the ICU for only 24 hours, with a total of length of stay of 5 days._x000D_ The patient evolved without any complication, showing in the control lab, a serum creatinine of 1.3 mg/dL. _x000D_ To the date there is no evidence of residual disease, clinical nor in the images.
The radical nephrectomy it’s the standard of care in the, level III inferior vena cava thrombus, in the setting of kidney cancer. It should be done in patients in conditions to have surgery.