Casestudies

A SURGICAL FEAT ACROSS SYSTEMS: TACKLING RENAL CELL CARCINOMA WITH INTRACARDIAC EXTENSION

||A Rare and High-Risk Multidisciplinary Triumph at Rela Institute||

A 47-year-old man presented to Rela Institute with a complex and life-threatening condition—clear cell renal cell carcinoma (RCC) that had extended beyond the kidney to invade the liver, adrenal gland, and, most critically, the right atrium of the heart via the inferior vena cava (IVC). What began as persistent cough and breathlessness led to a startling discovery—a massive retroperitoneal tumor with intracardiac extension, a rare presentation seen in less than 1% of RCC cases.

Imaging including PET-CT, MRI, and CT-pulmonary angiography revealed a large necrotic mass invading multiple organs and extending into the heart, causing a wrecking-ball effect on the tricuspid valve. With concurrent pulmonary embolism and cardiac compromise, the clinical scenario demanded swift, decisive, and collaborative action.

At the helm of this high-stakes case was Prof. Dr. Mohamed Rela, liver transplant surgeon, who led a multidisciplinary team involving Dr. Srinath Vijayasekharan and Dr. Senthil Kumar, cardiothoracic surgeons, along with experts in cardiology, cardio thoracic anesthesia, pulmonology, and endocrinology. Together, they charted out a bold surgical plan: a combined right hepatectomy, nephrectomy, adrenalectomy, and removal of the intracardiac tumor under cardiopulmonary bypass.

On December 5th, 2024, a thoracoabdominal approach with sternotomy allowed for successful resection of the cardiac mass and the tumor-laden organs. Despite significant blood loss, the surgical and anesthesia teams maintained hemodynamic stability throughout. The patient was extubated by post-op day two and shifted to the ward by day six. He was discharged on post-operative day 14, having defied the odds.

Histopathology confirmed clear cell RCC, notorious for vascular invasion and poor prognosis in advanced stages. Yet in this case, meticulous planning, surgical brilliance, and cohesive teamwork led to a smooth outcome.

This case underscores Rela Institute’s unparalleled multidisciplinary capabilities, showcasing what is possible when expertise, collaboration, and precision come together to face rare surgical challenges.

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