Sufian Chan, Aiman Adi and Salleh, Muhammad Azri and Nazmi, Muhammad Luqman and Ab. Rahman, Norhafiza and Othman, Mohd Yusran and Zahari, Zakaria (2022) Cavectomy following thrombectomy for Wilms’ Tumour with intracaval tumour thrombus: a case report and literature review. In: Malaysian Association of Paediatric Surgery 1st Annual Scientific Meeting, 4 Jun 2022, Putrajaya, Malaysia. (Unpublished)
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Abstract
Introduction: Wilms’t tumour is the commonest renal tumour in children. With a predisposition of forming tumour thrombus in blood vessels, tumour extension into renal veins and inferior vena cava (IVC) has been reported in up to 10% of cases. Neoadjuvant chemotherapy has been shown to promote intracaval tumour regression, however in cases of persistent thrombus, thrombectomy is required along with the radical nephrectomy via cavotomy. We shared a rare complication of thrombectomy which required a cavectomy. Case Summary: A 7-year-old girl was diagnosed with right Wilms’ tumour with tumour extension into IVC. After three courses of neoadjuvant chemotherapy, she developed duodenal obstruction caused by the tumour and the repeat imaging showed non-regression of the intracaval tumour thrombus. She underwent right radical nephrectomy with thrombectomy. However, Doppler assessment after the surgery revealed the IVC was filled with clots which persisted despite the administration of anticoagulant. With the concern of pulmonary embolism, she was subjected to another surgery to remove the clots. Intraoperatively, the IVC was found completely blocked at the level of intrahepatic IVC, thus decision was made for cavectomy without reconstruction. Post-operative recovery was uneventful. She was continued on chemotherapy and radiotherapy. Up until 18 months after surgery at the time of report, she remains well with no evidence of venous congestion and disease recurrent. Conclusion: Surgical excision of Wilms’ tumour with intravascular invasion is challenging. IVC wall injury following thrombectomy may end up with cavectomy. Cavectomy in children is otherwise safe and no major sequelae has been reported.
| Item Type: | Conference or Workshop Item (Poster) |
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| Uncontrolled Keywords: | Cavectomy, Wilms' tumour, intracaval tumour thrombus |
| Subjects: | R Medicine > R Medicine (General) R Medicine > RD Surgery R Medicine > RJ Pediatrics |
| Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button): | Kulliyyah of Medicine Kulliyyah of Medicine > Department of Surgery |
| Depositing User: | Dr Norhafiza Ab. Rahman |
| Date Deposited: | 09 Jun 2022 15:54 |
| Last Modified: | 09 Jun 2022 15:54 |
| URI: | http://irep.iium.edu.my/id/eprint/98234 |
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