Introduction: Historically, RCC (renal cell carcinoma) with level III and IV thrombus
(above the level of the liver) was deemed incurable. Considerable advances in the
identification and management of thrombus have permitted surgical resection of these
complex thromboses possible. Here we report our case series of two patients successfully
treated for level III and IV RCC vena caval tumor thrombus in the setting of small
urology and cardiothoracic units.
Case report: The first patient is a 65 years old Malay gentleman, who presented with
history of intermittent hematuria and abdominal discomfort. He was diagnosed to have
left RCC with vena caval tumor thrombus extending up to the right atrium (level IV
thromus). The second patient is a 61 years old patient presented with unusual weakness
in addition to night fever. He was diagnosed to have left RCC with vena caval tumor
thrombus extending up to the level of crus of right hemidiaphragm. Both patients’
were operated successfully using deep hypothermic circulartoy arrest (DHCA) with
minimal morbidity.
Discussion & Conclusion: The presence of venous involvement in RCC patient should
not be dismissed as having advanced disease with poor prognosis, the dissection of
vena caval tumor thrombus by using deep hypothermic circulatory arrest in the setting
of small unit, appears not to result in a significant increased in preoperative or
postoperative mortality.
Journal
Title
The Malaysian Journal of Medical Sciences, Volume 15, Supplement 1, 2008