An-Najah Staff

Introduction: Historically, RCC (renal cell carcinoma) with level III and IV thrombus (above the level of the liver) was deemed incurable. Considerable advances in the identification and management of thrombus have permitted surgical resection of these complex thromboses possible. Here we report our case series of two patients successfully treated for level III and IV RCC vena caval tumor thrombus in the setting of small urology and cardiothoracic units. Case report: The first patient is a 65 years old Malay gentleman, who presented with history of intermittent hematuria and abdominal discomfort. He was diagnosed to have left RCC with vena caval tumor thrombus extending up to the right atrium (level IV thromus). The second patient is a 61 years old patient presented with unusual weakness in addition to night fever. He was diagnosed to have left RCC with vena caval tumor thrombus extending up to the level of crus of right hemidiaphragm. Both patients’ were operated successfully using deep hypothermic circulartoy arrest (DHCA) with minimal morbidity. Discussion & Conclusion: The presence of venous involvement in RCC patient should not be dismissed as having advanced disease with poor prognosis, the dissection of vena caval tumor thrombus by using deep hypothermic circulatory arrest in the setting of small unit, appears not to result in a significant increased in preoperative or postoperative mortality.