The following is a summary of “Renal cell carcinoma with an “uncoiling” tumor thrombus: the intraoperative shift from level III to level IV,” published in the March 2024 issue of Surgery by Mata et al.
Renal cell carcinoma (RCC) with tumor thrombus (TT) presents a formidable surgical challenge, necessitating complete excision as the gold standard treatment. Particularly daunting are cases involving large tumor thrombi extending into the inferior vena cava (IVC) and right atrium, traditionally managed with cardiopulmonary bypass (CPB) techniques. However, recent years have witnessed a paradigm shift, with surgical strategies borrowed from liver transplantation aimed at circumventing the need for CPB. Here, researchers present a compelling case of RCC with a TT extending to level IIIc (beyond major hepatic veins), which, during surgery, unexpectedly “uncoiled” into the right atrium upon division of the IVC ligament, transitioning to a level IV thrombus.
Remarkably, despite this intraoperative development, the surgery was successfully navigated exclusively through an abdominal approach, obviating the need for CPB. Noteworthy was the invaluable role of intraoperative transesophageal echocardiography (TEE) monitoring, which enabled real-time visualization of the TT’s venous extension alteration, facilitating prompt modification of the surgical approach and averting a potentially catastrophic event. This case underscores the imperative of a multidisciplinary approach and highlights the utility of continuous intraoperative TEE monitoring in ensuring surgical precision and patient safety during complex RCC interventions.
Source: wjso.biomedcentral.com/articles/10.1186/s12957-024-03355-z