Abstract
The patient, a 71-year-old female, consulted a local physician, and a tumor was detected in the right kidney by ultrasonography. The patient was diagnosed as having renal cancer with a tumor thrombus in the inferior vena cava (IVC), and referred to our department. Preoperative examination suspected that the tip of the tumor thrombus reached the region proximal from the hepatic vein. After abdominal median incision and thoracotomy at the ninth costal space, the right hepatic lobe was displaced, and the lesion was found in the IVC. The lesion was confirmed to be a floating tumor thrombus by ultrasonography performed during surgery. Since it was indicated by the blocking tests that blood flow could not be maintained under blocking of the region proximal from the hepatic vein, blocking of the IVC on the distal side from the hepatic vein and right renal vein was performed after the tumor thrombus was manually moved toward the distal side. The tumor thrombus in the cava was removed en bloc together with the renal tumor. The postoperative course was good. The patient was discharged, and no evidence of further disease has been seen in the 47 months since the operation.
In some patients with a tumor thrombus in the IVC caused by renal cancer, removal of the tumor thrombus under simple blocking is possible by detailed preoperative evaluation and ultrasonography and blocking tests during surgery, if it reachs the region proximal from the hepatic vein.
