Simultaneous Cesarean Section and Radical Nephrectomy With Tumor Thrombectomy During Pregnancy
Renal cell carcinoma (RCC) is uncommon during pregnancy. Accurate and timely diagnosis and careful preoperative planning are essential to optimize the patient outcomes. A 27-year-old pregnant woman presented with a large mass in left kidney and inferior vena cava (IVC) tumor thrombus, diagnosed at 33 weeks gestation. She was evaluated with an initial impression of pyelonephritis at other institutions and referred to our center after a delay of more than 3 weeks. RCC with IVC tumor thrombus has the potential to increase the likelihood of thromboembolic events including pulmonary embolism during pregnancy. Furthermore, simultaneous radical nephrectomy with IVC thrombectomy and Cesarean section (CS) is challenging and might be associated with significant intraoperative blood loss. After consultation with an obstetrician and cardiac surgery team, our patient underwent CS and simultaneous left radical nephrectomy with IVC thrombectomy at 34 weeks gestation. The postoperative course was uneventful and histologic analysis revealed pT3bN0M0 papillary RCC.
Khaled, H., N.A. Lahloubi, and N. Rashad, Review on renal cell carcinoma and pregnancy: A challenging situation. J Adv Res, 2016. 7(4): p. 575-80.
Brenner, B. and I. Avivi, Cancer in pregnancy: the role of thromboprophylaxis. Thromb Res, 2012. 129 Suppl 1: p. S20-1.
Katayama, H., et al., A case of renal cell carcinoma with inferior vena cava tumor thrombus diagnosed during pregnancy. Urol Int, 2014. 92(1): p. 122-4.
Ghanney EC., et al., Renal cell carcinoma with inferior vena cava thrombus extending to the right atrium diagnosed during pregnancy. Ther Adv Urol. 2017 Apr 16;9(6):155-159.
Thompson, R.H., et al., Renal cell carcinoma in young and old patients--is there a difference? J Urol, 2008. 180(4): p. 1262-6; discussion 1266.
Loughlin, K.R., The management of urological malignancies during pregnancy. Br J Urol, 1995. 76(5): p. 639-44.
Shim, M.H., et al., Clinical characteristics and outcome of cancer diagnosed during pregnancy. 2016. 59(1): p. 1-8.
Lawindy, S.M., et al., Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int, 2012. 110(7): p. 926-39.
Gnessin, E., Y. Dekel, and J. Baniel, Renal cell carcinoma in pregnancy. Urology, 2002. 60(6): p. 1111.
Casella, R., et al., Surgical management of renal cell carcinoma during the second trimester of pregnancy. Urol Int, 2006. 76(2): p. 180-1.
Bettez, M., et al., Fatal fast-growing renal cell carcinoma during pregnancy. J Obstet Gynaecol Can, 2011. 33(3): p. 258-61.
|Issue||Vol 57, No 1 (2019)|
|Inferior vena cava Pregnancy Renal cell carcinoma Tumor thrombus|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|