AB192. SOH25_AB_245. Mastering complex oncology surgery: radical nephrectomy and inferior vena cava (IVC) thrombectomy for renal cell carcinoma with extensive caval thrombus

Background: Renal cell carcinoma (RCC) with extensive intravascular tumour thrombus (TT) is a complex and challenging clinical entity.

Methods: We present a case of a 70-year-old female who underwent left radical nephrectomy and inferior vena cava (IVC) thrombectomy for RCC with a TT extending into the hepatic portion of the IVC. Preoperative imaging, including computed tomography (CT) and magnetic resonance imaging (MRI) venogram, identified a 94 mm renal mass with an 8 cm TT, consistent with clear cell RCC, staged pT3a N0. Postoperative complications included a pulmonary embolism, requiring anticoagulation therapy. The patient’s medical history included hypothyroidism, osteoporosis, and chronic lymphocytic leukaemia in remission.

Results: RCC, which accounts for 80–90% of renal malignancies, frequently presents with nonspecific symptoms or is incidentally found. The propensity of RCC for vascular invasion results in TT in 4–10% of cases, which can extend into the IVC and even the right atrium. Surgical removal of the tumour and thrombus, through nephrectomy and IVC thrombectomy, remains the gold standard of treatment. However, the presence of TT significantly complicates surgery and worsens prognosis. Managing IVC TT requires precise thrombus control to prevent embolic events, followed by effective thrombectomy. Postoperative care may include anticoagulation for thromboembolic complications.

Conclusions: This case underscores the complexities of treating RCC with IVC TT and highlights the critical role of surgical intervention, careful postoperative management, and long-term follow-up to optimise patient outcomes.

Keywords: Renal cell carcinoma (RCC); tumour thrombus (TT); nephrectomy; thrombectomy; inferior vena cava (IVC)