Abstract
Locally advanced renal cell carcinoma is associated with a malignant thrombus of the inferior vena cava (IVC) in approximately 10 % of cases. Complete tumor resection in the form of a radical nephrectomy and caval thrombectomy is the most effective curative option in indicated cases.
In some instances, resection of the IVC is necessary. Cadaveric allografts or synthetic vascular prostheses represent the most commonly used grafts.
A malignant thrombus of the IVC is a significant adverse prognostic factor, and it is associated with a higher risk of disease recurrence. The time to isolated recurrence after primary surgery is between 19 and 36 months.
Case: A 64-year-old male with locally advanced right-sided renal cell carcinoma and a malignant IVC thrombus extending below the hepatic veins underwent a radical nephrectomy and resection of the IVC with reconstruction using a cadaveric allograft. Twenty-nine months after the initial surgery, we performed resection of the locally recurrent tumor with repeated replacement of the IVC with a synthetic prosthesis.
The patient is in good health 3 months after the second resection. Conclusion: Radical surgical resection of a renal tumor with caval thrombectomy or replacement due to malignant IVC thrombus remains the only therapeutic option associated with improved survival rates.
In our case, we carried out repeated replacement of the IVC while treating primary and recurrent disease.