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

## TL;DR

A case of advanced kidney cancer with a tumor thrombus in the inferior vena cava was successfully treated without cardiopulmonary bypass using a novel surgical technique.

## Contribution

A new surgical method for removing Level IV tumor thrombus without cardiopulmonary bypass is demonstrated.

## Key findings

- Ultrasonography can provide insights into tumor thrombus dynamics.
- Retrograde blood flow in the IVC can move floating tumor thrombus caudally for easier removal.
- Some Level IV tumor thrombus cases can be resected without cardiopulmonary bypass.

## Abstract

We preoperatively evaluated the tumor thrombus of right renal cell carcinoma cT3cN0M0 extending close to the right atrium using abdominal ultrasound. We found that invasion of the inferior vena cava (IVC) by the tumor thrombus was limited to the caudal side of the hepatic vein. We clamped the caudal IVC, left renal, and hepatic veins but not the cranial IVC. Incising the IVC in this situation caused retrograde flow, moving the floating tumor thrombus caudally. This enabled rapid extraction of the tumor thrombus and cranial IVC clamping below the hepatic vein. Consequently, tumor thrombectomy was successfully performed without cardiopulmonary bypass.

•Information on tumor thrombus dynamics can be obtained by ultrasonography.•Backflow of blood in IVC moves the floating tumor thrombus caudally.•After tumor thrombus removal, the cranial IVC can be clamped at a more caudal site.•Some Level IV tumor thrombus can be resected without cardiopulmonary bypass.

Information on tumor thrombus dynamics can be obtained by ultrasonography.

Backflow of blood in IVC moves the floating tumor thrombus caudally.

After tumor thrombus removal, the cranial IVC can be clamped at a more caudal site.

Some Level IV tumor thrombus can be resected without cardiopulmonary bypass.