Two-Stage Tumor Resection for Locally Advanced Renal Cell Carcinoma With Level IV Tumor Thrombus and Pulmonary Embolism: A Case Report

Q4 Medicine

IJU Case Reports Pub Date : 2025-06-16 DOI:10.1002/iju5.70045

Takanari Kambe, Kei Mizuno, Yuki Teramoto, Takayuki Sumiyoshi, Yuki Kita, Kimihiko Masui, Takayuki Goto, Shusuke Akamatsu, Ryoichi Saito, Takashi Kobayashi

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Abstract

Introduction

We report a case of renal cell carcinoma with an inferior vena cava tumor thrombus extending into the right atrium and pulmonary embolism, treated using a staged surgical approach.

Case Presentation

A man in his 60s was diagnosed with left clear cell renal cell carcinoma with a tumor thrombus extending to the right atrium, posing a risk of sudden death. Given the high perioperative risk, complete resection in a single session was infeasible. Preoperative administration of a tyrosine kinase inhibitor showed limited effectiveness, and the patient developed pulmonary embolism. An initial thoracotomy was performed to urgently remove the pulmonary artery and right atrial thrombus, along with as much infra-diaphragmatic thrombus as feasible. This was followed by open radical nephrectomy and abdominal inferior vena cava thrombectomy.

Conclusion

The staged approach enabled curative nephrectomy despite the presence of tumor thrombus and pulmonary embolism.

Abstract Image

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局部晚期肾细胞癌合并IV级肿瘤血栓及肺栓塞的两期肿瘤切除术1例

我们报告一例肾细胞癌伴下腔静脉肿瘤血栓延伸至右心房并肺栓塞，采用分阶段手术方法治疗。一名60多岁的男性被诊断为左透明细胞肾细胞癌，肿瘤血栓延伸至右心房，有猝死的危险。考虑到高围手术期风险，单次完全切除是不可行的。术前给予酪氨酸激酶抑制剂效果有限，患者发生肺栓塞。首先行开胸术，紧急切除肺动脉和右心房血栓，以及尽可能多的膈下血栓。随后行开放性根治性肾切除术和腹腔下腔静脉血栓切除术。结论尽管存在肿瘤血栓和肺栓塞，分期入路仍可治愈肾切除术。

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