A case of right renal cell carcinoma with an inferior vena cava tumor thrombus extending above the diaphragm resected without cardiopulmonary bypass

Fig. 1. Contrast-enhanced computed tomography (a) Tumor with heterogeneous enhancement in the early contrast phase (arrow) and tumor thrombus extending from the right renal vein into the inferior vena cava (triangle). (b–c) The tip of the tumor thrombus extends beyond the diaphragm, approaching the vicinity of the right atrium.

Fig. 2. Abdominal ultrasonography The IVC region invaded by the tumor thrombus (yellow triangle) is located below the hepatic vein (blue arrow). The tumor thrombus above the hepatic vein is mobile and floating, while the IVC site where the tumor thrombus has invaded is nearly occluded, resulting in very low blood flow. IVC; inferior vena cava.

Fig. 3. Tumor thrombus removal (a) The IVC was clamped below the tumor thrombus, as well as at the contralateral renal vein and hepatic vein, before incising the IVC without clamping it above the tumor thrombus (red bar). (b) Backflow bleeding (arrow) from cranial to caudal occurred at the incision site. Using this backflow of blood, we were able to quickly and easily extract the floating tumor thrombus from the IVC. (c) We were able to clamp the IVC below the hepatic vein sooner and release the clamp on the hepatic vein in a short time. IVC; inferior vena cava.

Fig. 4. Histopathological findings The histopathological diagnosis was grade III clear-cell renal cell carcinoma. The tumor thrombus has invaded the IVC walls (triangle), and the surgical margins are negative. IVC; inferior vena cava.