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

## TL;DR

A patient with advanced kidney cancer and dangerous blood clots was successfully treated using a two-step surgical approach.

## Contribution

A successful two-stage surgical strategy for a high-risk renal cell carcinoma case with tumor thrombus and pulmonary embolism.

## Key findings

- A staged surgical approach allowed safe removal of tumor thrombus and pulmonary embolism.
- Initial thoracotomy reduced immediate risks before completing the nephrectomy.
- The method enabled curative treatment despite high perioperative risks.

## Abstract

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.

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.

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