Department of Vascular Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo.
Department of Urology, University Clinical Center of Kosovo, Prishtina, Kosovo.
J Med Case Rep. 2024 Apr 23;18(1):201. doi: 10.1186/s13256-024-04517-z.
Renal cell carcinomas are the most common form of kidney cancer in adults. In addition to metastasizing in lungs, soft tissues, bones, and the liver, it also spreads locally. In 2-10% of patients, it causes a thrombus in the renal or inferior vena cava vein; in 1% of patients thrombus reaches the right atrium. Surgery is the only curative option, particularly for locally advanced disease. Despite the advancements in laparoscopic, robotic and endovascular techniques, for this group of patients, open surgery continues to be among the best options.
Here we present a case of successful tumor thrombectomy from the infrahepatic inferior vena cava combined with renal vein amputation and nephrectomy. Our patient, a 58 year old Albanian woman presented to the doctors office with flank pain, weight loss, fever, high blood pressure, night sweats, and malaise. After a comprehensive assessment, which included urine analysis, complete blood count, electrolytes, renal and hepatic function tests, as well as ultrasonography and computed tomography, she was diagnosed with left kidney renal cell carcinoma involving the left renal vein and subhepatic inferior vena cava. After obtaining informed consent from the patient we scheduled her for surgery, which went well and without complications. She was discharged one week after to continue treatment with radiotherapy, chemotherapy, and immunotherapy.
Open surgery is a safe and efficient way to treat renal cell carcinoma involving the renal vein and inferior vena cava. It is superior to other therapeutic modalities. When properly done it provides acceptable long time survival and good quality of life to patients.
肾细胞癌是成年人中最常见的肾癌类型。除了转移到肺部、软组织、骨骼和肝脏外，它还会局部扩散。在 2-10%的患者中，它会在肾静脉或下腔静脉中形成血栓；在 1%的患者中，血栓会到达右心房。手术是唯一的治愈选择，特别是对于局部晚期疾病。尽管腹腔镜、机器人和血管内技术取得了进步，但对于这组患者，开放手术仍然是最佳选择之一。
在这里，我们报告了一例成功的肝下下腔静脉肿瘤血栓切除术，同时进行肾静脉切断和肾切除术。我们的患者是一位 58 岁的阿尔巴尼亚女性，因腰痛、体重减轻、发热、高血压、夜间出汗和不适就诊。经过全面评估，包括尿液分析、全血细胞计数、电解质、肾功能和肝功能检查以及超声和计算机断层扫描，她被诊断为左肾癌累及左肾静脉和肝下下腔静脉。在获得患者知情同意后，我们为她安排了手术，手术顺利，无并发症。她在一周后出院，继续接受放疗、化疗和免疫治疗。
开放手术是治疗累及肾静脉和下腔静脉的肾细胞癌的安全有效的方法。它优于其他治疗方式。如果正确进行，它可以为患者提供可接受的长期生存和良好的生活质量。
