A Case of Wilms' Tumor With Intracaval Involvement

Abstract

Intracaval involvement of Wilms' tumor is a rare condition. This is a report of a 7 -year-old girl with intracaval involvement of Wilms' tumor. The tumor originated in the left kidney and the tumor thrombus extended into the retrohepatic inferior vena cava through the renal vein. Total excision (kidney and thrombus) was accomplished safely by venacavotomy with proximal and distal vascular control. The patient is in good health with postoperative radiation and chemotherapy. Major intraoperative hemorrhage, bowel obstruction, occlusion of the inferior vena cava after removal of the thrombus, nonlethal intraoperative cardiac arrest, and pulmonary embolism have been reported as complications of surgical management. Surgical management of Wilms' tumor extending into the inferior vena cava is a daunting surgical challenge. Careful preoperative evaluation of the tumor thrombus to define the cephalad limit of venous extension and appropriate vascular control are important to avoid complications.