# Surgical management of renal cell carcinoma with extension into the inferior vena cava and right atrium: A case report

## TL;DR

This case report describes the surgical removal of a kidney tumor that spread to the inferior vena cava and right atrium using cardiopulmonary bypass.

## Contribution

The paper presents a case where CPB alone was safely used for a specific type of advanced RCC without needing deep hypothermic circulatory arrest.

## Key findings

- A 40-year-old male with RCC extending into the IVC and right atrium was successfully treated with CPB alone.
- CPB without DHCA is a safe option for selected Mayo grade 4 cases with non-adherent thrombus.
- DHCA should be used when thrombus adhesion or valve involvement is present.

## Abstract

Metastatic heart tumors are more prevalent than primary cardiac tumors. Renal cell carcinoma (RCC) is one of the tumor that can spread to the Inferior Vena Cava (IVC) to the right heart chamber. We present the Case of RCC with extension into the IVC and Right Atrium with surgical treatment and approach.

40-years old male experienced shortness of breath 3 months prior. PET CT-scan showed Lobulated hypermetabolic mass with malignant aspect measuring ±68.6 × 64.9 mm with necrotic area in the right renal lower pole corresponds to RCC. Tumor thrombus (TT) of the inferior vena cava reaches the right atrium. Transthoracic echocardiography showed multiple lobe thrombus from the IVC entering the RA. Surgical therapy with excision of right kidney tumor and TT into the IVC and RA with cardiopulmonary bypass (CPB).

The thrombus was Mayo grade 4, preoperative imaging and intraoperative findings confirmed a short, mobile, non-adherent thrombus without caval wall invasion. Complete removal was achieved with CPB alone, omitting DHCA. Intraoperative transoesophageal echocardiography guided safe extraction, reducing procedural complexity and avoiding DHCA-related risks.

Management of RCC with RA extension requires precise assessment of thrombus level, morphology, and metastatic status. In selected Mayo grade 4 cases without wall adhesion, friable thrombus, or valve involvement, CPB without DHCA is a safe alternative, minimizing perioperative morbidity. DHCA should be prioritized when adhesion, friability, or valve extension is present.

•Metastatic heart tumors are more prevalent than primary cardiac tumors•Renal cell carcinoma (RCC) is one of the tumor that can spread to the Inferior Vena Cava (IVC) to the right heart chamber.•Surgical management of RCC with tumor thrombus (TT) can be performed under cardiopulmonary bypass (CPB), with or without deep hypothermic circulatory arrest (DHCA), depending on thrombus morphology and wall invasion.•Selected Mayo grade 4 cases without caval wall adhesion or thrombus fixation may be safely managed with CPB alone, while DHCA should be reserved for complex or adherent thrombi.

Metastatic heart tumors are more prevalent than primary cardiac tumors

Renal cell carcinoma (RCC) is one of the tumor that can spread to the Inferior Vena Cava (IVC) to the right heart chamber.

Surgical management of RCC with tumor thrombus (TT) can be performed under cardiopulmonary bypass (CPB), with or without deep hypothermic circulatory arrest (DHCA), depending on thrombus morphology and wall invasion.

Selected Mayo grade 4 cases without caval wall adhesion or thrombus fixation may be safely managed with CPB alone, while DHCA should be reserved for complex or adherent thrombi.