Intraoperative migration of an inferior vena cava tumour detected by transesophageal echocardiography.

摘要

Direct extension of renal cell carcinoma into the inferior vena cava (IVC) is observed in 3% to 25% of cases. Based on the extent of IVC involvement, these tumours are classified as level I (infrahepatic IVC), level II (retrohe-patic IVC to hepatic veins), and level III (right atrium). The surgical approach varies for each level. Level I and II tumours are commonly resected through a laparotomy, with an infrahepatic or suprahepatic IVC clamp with or without liver mobilization. Level III tumours require a multidisciplinary surgical approach that involves cardiac and hepatobiliary surgeons in order to gain access to the proximal IVC. Cardiopulmonary bypass standby is often made available for these cases. Tumour disruption and pulmonary embolization is a rare but well-recognized complication that occurs in up to 5.4% of resections of renal cell carcinoma with IVC involvement.