Key result
A 49-year-old male with renal cell carcinoma and severe coronary artery disease successfully underwent curative tumor resection and thrombectomy without prior percutaneous coronary intervention.
Case Report (n=1)
No
In a patient with severe CAD and RCC with IVC extension, immediate tumor resection without prior PCI was successfully performed, highlighting the importance of multidisciplinary decision-making when balancing cancer mortality against perioperative cardiac risk.
A 49-year-old male with untreated type 2 diabetes and a family history of coronary artery disease (CAD) presented with right flank pain and profound progressive dyspnea on exertion to the emergency department of Ben Taub Hospital, a tertiary county hospital. Workup revealed right renal cell carcinoma with metastatic extension into the inferior vena cava (IVC). In addition, the patient had significant CAD with 95% occlusion of the proximal left anterior descending coronary artery amenable to percutaneous coronary intervention (PCI). After multidisciplinary discussions involving cardiovascular anesthesiology, cardiology, urology, and cardiothoracic surgery, it was estimated that the mortality benefit of immediate tumor resection outweighed the patient's need for PCI and further cardiac optimization. The patient underwent curative resection and thrombectomy under transesophageal echocardiography (TEE) guidance without complication, made an expedient recovery, and was discharged home on postoperative day seven.
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Gashler et al. (2023) conducted a case report in Renal cell carcinoma with inferior vena cava extension and severe coronary artery disease (n=1). Open right radical nephrectomy with inferior vena cava thrombectomy was evaluated on Surgical success and perioperative major adverse cardiac events. A 49-year-old male with renal cell carcinoma and severe coronary artery disease successfully underwent curative tumor resection and thrombectomy without prior percutaneous coronary intervention.
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