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

## TL;DR

This case report details the successful anesthetic management of a patient with advanced kidney cancer and a blocked vein, emphasizing careful planning and teamwork.

## Contribution

The paper presents a novel case of anesthetic management for renal cell carcinoma with complete IVC obstruction, highlighting strategies for hemodynamic stability.

## Key findings

- A multimodal anesthetic approach successfully managed hemodynamic instability during IVC tumor resection.
- Intraoperative invasive monitoring and fluid/vasopressor therapy enabled responsive care.
- The patient had an uncomplicated postoperative recovery in the ICU.

## Abstract

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.