Renal cell carcinoma with an "uncoiling" tumor thrombus: intraoperative shift from level III to level IV.
World J Surg Oncol
; 22(1): 76, 2024 Mar 07.
Article
em En
| MEDLINE
| ID: mdl-38454471
ABSTRACT
BACKGROUND:
The gold standard treatment for renal cell carcinoma (RCC) with tumor thrombus (TT) is complete surgical excision. The surgery is complex and challenging to the surgeon, especially with large tumor thrombus extending into the inferior vena cava (IVC) and right atrium. Traditionally, these difficult cases required the use of cardiopulmonary bypass (CPB) with or without deep hypothermic cardiac arrest, but in recent years, different surgical techniques derived from the field of liver transplantation have been used in efforts to avoid CPB. CASE PRESENTATION We present a case of RCC with TT level IIIc (extending above major hepatic veins) that "uncoiled" intraoperatively into the right atrium after division of the IVC ligament, transforming into a level IV TT. Despite the new TT extension, the surgery was successfully completed exclusively through an abdominal approach without CPB and while using intraoperative transesophageal echocardiography (TEE) monitoring and a cardiothoracic team standby.CONCLUSIONS:
This case highlights the need for a multidisciplinary approach and the utility of intraoperative continous TEE monitoring which helped to visualize the change of the TT venous extension, allowing the surgical teamto modify their surgical approach as needed avoiding a catastrophic event.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Trombose
/
Carcinoma de Células Renais
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Neoplasias Renais
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Células Neoplásicas Circulantes
Limite:
Humans
Idioma:
En
Revista:
World J Surg Oncol
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Estados Unidos