奇美醫學中心 外科部 泌尿外科，1泌尿腫瘤科，2心臟血管外科
Surgical management in a patient with renal cell carcinoma with inferior vena cava thrombosis and antrialmetastasis - Case report and literature review
Ming-Chieh Kuo, Steven Kuan-Hua Huan1, Nan-Chun Wu2
Division of Urology, Department of Surgery, 1Division of Uro-Oncology
2Divisdion of Cardiovascular Surgery, Chi Mei Medical Center, Tainan, Taiwan
Patients with metastatic renal cell carcinoma (RCC) or who develop metastases following prior treatment are generally managed with systemic therapy, primarily using agents targeting the vascular endothelial growth factor (VEGF) pathways. However, surgery continues to play an important role in the management of these patients in some ways. A nephrectomy can be a part of a combined approach to decrease the bulk of tumor prior to systemic therapy, while a metastasectomy can be performed in patients with one or a very limited number of metastases.
We presented a 75 years-old gentleman who sufferedfrom right renal tunorwith inferior vena cava thrombosis and right antrum metastasis.The chief complaint was dyspnea and poor appetite for 6 months. For pending heart failure, surgical intervention including right transperitonealredical nephrectomy andresection of inferior vena cava and right antrial tumor was performed.
As metastasectomy of lung, bone, brain, and intra-abdominal organs had been reported according to previous literature, clinical experience in metastasectomy of vascular system including major vessel and heart was limited. We reviewed the management of these patients and surgical outcome if surgical intervention was performed according to previous literature.