Double inferior vena cava with left renal cell carcinoma Mayo Ⅱ tumor thrombus:a case report and literature review / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the safety and feasibility of operation to treat left renal carcinoma with Mayo Ⅱ tumor thrombus in double inferior vena cava.Methods The clinical data from a 52-year-old male suffered painless gross hematuria for 6 days and left back pain for 3 days was analyzed retrospectively.Enhanced CT examination of kidneys showed double inferior vena cava malformation.The confluence level of the left and the right inferior vena cava was at L1/2 disc level by a 80 degree angle.The left inferior pole of kidney showed an irregular soft tissue density,the size was 6.1 cm × 4.5 cm × 5.6 cm,considering the possibility of renal cancer.The tumor thrombus invaded into the inferior vena cava below the hepatic vein with a maximum diameter of about 3.2 cm.The top of the tumor thrombus was about 6.0 cm above the left renal vein.It showed a Mayo Ⅱ] tumor thrombus.Preoperative diagnosis was left renal carcinoma with Mayo Ⅱ tumor thrombus in double inferior vena cava.The patient underwent radical nephrectomy under general anesthesia.We separated hepatic inferior vena cava,right renal vein,right inferior vena cava,left inferior vena cava and left renal vein.Sequential occlusion was completed of left inferior vena cava,right inferior vena cava,right renal vein,hepatic inferior vena cava.Vascular wall of inferior vena cava was cut open and the tumor thrombus was removed at the level of inferior vena cava bifurcation.During the operation,the wall of left inferior vena cava was invaded by tumor thrombus.So all the left kidney,the left renal vein,the left inferior vena cava invaded by tumor thrombus were resected.We sutured the vena cava incision continuously.Sequential occlusions were removed of right renal vein,right inferior vena cava,hepatic inferior vena cava.We clamped the vessel wall of right inferior vena cava by auricle clamp and made an incision longitudinally.Then we made an end to side anastomosis of the left and right inferior vena cava.Results The surgical procedure was successful and the postoperative recovery was favorable.The operation time was 442 min.And blood loss was 3 000 ml.The postoperative pathology result showed that the tumor was clear cell renal cell carcinoma,2016 WHO/ISUP grade was Ⅱ] to Ⅲ.There was no metastasis of left renal hilum lymph node,abdominal aorta and vena cava lymph node.There was no metastasis of adrenal gland.The abdominal cavity drainage tube and the urinary catheter was removed 7 days postoperatively.He was discharged from hospital 8 days postoperatively.There were no obvious postoperative complications.The patient was followed up for 3 months and there was no tumor recurrence or metastasis.Conclusions Our initial clinical result show that radical nephrectomy,Mayo]Ⅱ venous thrombectomy,left and right inferior vena cava end to side anastomosis is safe and effective.But the operation is difficult and complex.