TUMOUR THROMBUS ASSOCIATED WITH RENAL CELL CARCINOMA: A RARE CASE OF DELICATE SURGERY

Metastatic renal cell carcinoma is in itself a serious and potentially fatal cancer, but when renal vein thrombus is added, the patients short-term prognosis worsens and surgery becomes even more complicated and mutilating. Four to ten per cent of kidney tumours invade the inferior vena cava and develop tumour extension into the renal vein and inferior vena cava. Only 1% has thrombus extension into the right atrium, a rare situation but one with a guarded prognosis. Cytoreductive nephrectomy is associated with an improvement in overall survival in patients without thrombus and in those with tumour thrombus limited to the renal vein and infra-diaphragmatic inferior vena cava with the advent of immunotherapy. Our article presents the case of a 73-year-old female patient who was admitted to Mohamed V Military Hospital of instruction for investigation of lumbar pain and imaging combined with a biopsy of the renal mass confirmed a metastatic renal tumour with thrombus extending to the junction of the renal vein with the inferior vena cava. The multidisciplinary consultation meeting decided to perform an extended total nephrectomy prior to systemic treatment and the challenge was to also remove the tumour thrombus from the renal vein and avoid any associated complications, which could be fatal.