Perioperative management of two patients with renal malignant tumor involving the vena cava

Tsunehisa Sato, Mutsuhito Kikura, Go Kobori, Shuhei Goto, Takeshi Yoshikawa, Seiji Moroi, Shiro Koi, Akira Iwai, Harutaka Inoue, Naoki Teratani, Junichi Kaganoi, Noboru Nakayama, Kazuhiro Takatoku, Hiroomi Nishio, Takayuki Aoki, Junichiro Nishizawa, Hiroshi Kanda, Eiji Shinoda

Research output: Contribution to journalArticlepeer-review


Two patients underwent resection of renal malignant tumors involving vena cava. Such tumors occasionally extend to the inferior vena cava with tumor thrombus and invasion to the lymph nodes and adjacent organs. Perioperative management of patients with these tumors is difficult because of the risk of pulmonary embolism and massive bleeding, and requires appropriate cooperation among the surgical team. In case 1, a 56-year-old man, renal cell carcinoma with tumor thrombus had extended into the intrahepatic vena cava. It was resected after isolating the liver from vena cava and incising the cross-clamped inferior vena cava without extracorporeal circulation or blood transfusion. A prosthetic graft replaced the inferior vena cava. In case 2, a 64-year-old woman, renal pelvis cancer adhered to the inferior vena cava and the mesentery with enlarged lymph nodes. It was separated from the inferior vena cava and removed with the ascending colon. The patient received a blood transfusion of approximately 2,000 ml. Cardiomyopathy associated with a left ventricular outflow tract pressure gradient of 100 mmHg required perioperative management. After surgery, both patients underwent controlled ventilation in the intensive care unit. After recovery, they were discharged without complications. We discuss perioperative management, with regard to the level of the tumor extension and perioperative complications.

Original languageEnglish
Pages (from-to)470-473
Number of pages4
JournalJapanese Journal of Anesthesiology
Issue number4
Publication statusPublished - 04-2013

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine


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