Anesthetic Management of Recurrent Renal Cell Carcinoma With Complete Obstruction of Inferior Vena Cava (IVC): A Case Report.

We report the perioperative management of a 67-year-old woman with recurrent renal cell carcinoma (RCC) complicated by complete inferior vena cava (IVC) obstruction, confirmed intraoperatively, who underwent en bloc resection of the tumor and involved segment of the IVC. Significant anesthetic challenges included stage 4 chronic kidney disease (CKD), intraoperative hemodynamic instability related to tumor manipulation, and the need to anticipate potential physiological effects of IVC clamping and unclamping. A multimodal anesthetic strategy including general anesthesia, bilateral rectus sheath block, invasive monitoring, and individualized fluid and vasopressor therapy allowed for responsive management of hemodynamic fluctuations. Postoperatively, the patient had an uncomplicated recovery in the intensive care unit. This report highlights the importance of meticulous perioperative planning, intraoperative adaptability, and multidisciplinary coordination in managing complex and evolving oncovascular scenarios.