A case of right renal cell carcinoma with an inferior vena cava tumor thrombus extending above the diaphragm resected without cardiopulmonary bypass

Abstract

We preoperatively evaluated the tumor thrombus of right renal cell carcinoma cT3cN0M0 extending close to the right atrium using abdominal ultrasound. We found that invasion of the inferior vena cava (IVC) by the tumor thrombus was limited to the caudal side of the hepatic vein. We clamped the caudal IVC, left renal, and hepatic veins but not the cranial IVC. Incising the IVC in this situation caused retrograde flow, moving the floating tumor thrombus caudally. This enabled rapid extraction of the tumor thrombus and cranial IVC clamping below the hepatic vein. Consequently, tumor thrombectomy was successfully performed without cardiopulmonary bypass.