Two-Stage Tumor Resection for Locally Advanced Renal Cell Carcinoma With Level IV Tumor Thrombus and Pulmonary Embolism: A Case Report.

INTRODUCTION

We report a case of renal cell carcinoma with an inferior vena cava tumor thrombus extending into the right atrium and pulmonary embolism, treated using a staged surgical approach.

CASE PRESENTATION

A man in his 60s was diagnosed with left clear cell renal cell carcinoma with a tumor thrombus extending to the right atrium, posing a risk of sudden death. Given the high perioperative risk, complete resection in a single session was infeasible. Preoperative administration of a tyrosine kinase inhibitor showed limited effectiveness, and the patient developed pulmonary embolism. An initial thoracotomy was performed to urgently remove the pulmonary artery and right atrial thrombus, along with as much infra-diaphragmatic thrombus as feasible. This was followed by open radical nephrectomy and abdominal inferior vena cava thrombectomy.

CONCLUSION

The staged approach enabled curative nephrectomy despite the presence of tumor thrombus and pulmonary embolism.