Laparoscopic Vena Cava Thrombectomy and Radical Nephrectomy in a Malignant Pheochromocytoma Case

Abstract

Pheochromocytomas with vena cava thrombus are extremely rare, with only a few cases reported in the literature. Radical nephrectomy with adrenalectomy and inferior vena cava (IVC) thrombectomy is the treatment of choice. However, it is a challenging procedure and its surgical approach is yet to be standardized. We present a case of a 49-year-old male incidentally diagnosed with a pheochromocytoma with aggressive local invasion and a level 1 vena cava thrombus. A laparoscopic right radical nephrectomy with right adrenalectomy, IVC thrombectomy and cavorraphy. A detailed revision of the technique is performed and compared with current strategies for pheochromocytoma optimal treatment. Renal and adrenal masses with vena cava thrombus are associated with high morbidity and mortality, particularly in the case of pheochromocytoma. The management is complex but minimally invasive surgery can be performed safely in the context of an experienced multidisciplinary team.