{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T21:22:04Z","timestamp":1793395324995,"version":"4.5.0"},"reference-count":9,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,13]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:p>Renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus represents a high-risk surgical and anaesthetic scenario requiring meticulous multidisciplinary coordination. We report the peri-operative management of a patient in his late 60s with right-sided clear-cell RCC extending to level III of the IVC, who underwent open radical nephrectomy with tumour thrombectomy under continuous transoesophageal echocardiographic monitoring. The procedure was complicated by a total blood loss of 6.4\u2009L and a 26-min period of supra-hepatic IVC clamping. Haemodynamic stability was maintained through early activation of a predefined massive transfusion protocol, vasopressor support and real-time transoesophageal echocardiography-guided assessment of cardiac filling and thrombus position. A regional anaesthesia\u2013based, opioid-sparing analgesic strategy facilitated on-table extubation despite major fluid shifts and prolonged vascular clamping. The patient had an uncomplicated postoperative course and was discharged on postoperative day five. This case demonstrates that, within an established peri-operative framework, emphasis on anticipatory planning, structured blood-management strategies and continuous intraoperative imaging can support predictable recovery even in complex caval thrombectomy surgery.<\/jats:p>","DOI":"10.1136\/bcr-2025-270503","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:20:20Z","timestamp":1770049220000},"page":"e270503","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Navigating complexity: anaesthetic management of renal cell carcinoma with inferior vena cava thrombus for radical nephrectomy and thrombectomy"],"prefix":"10.1136","volume":"19","author":[{"given":"Shaik M Hammed","family":"Murtaza","sequence":"first","affiliation":[{"name":"Anaesthesiology, All India Institute of Medical Sciences Mangalagiri, Mangalagiri, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meka","family":"Sree Pooja","sequence":"additional","affiliation":[{"name":"Anaesthesiology, All India Institute of Medical Sciences Mangalagiri, Mangalagiri, Andhra Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,2]]},"reference":[{"key":"2026020208201138000_19.2.e270503.1","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1016\/j.eururo.2025.02.020","article-title":"European Association of Urology Guidelines on Renal Cell Carcinoma: The 2025 Update","volume":"87","author":"Bex","year":"2025","journal-title":"Eur Urol"},{"key":"2026020208201138000_19.2.e270503.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2024.05.537"},{"key":"2026020208201138000_19.2.e270503.3","doi-asserted-by":"crossref","first-page":"1219","DOI":"10.1002\/jso.25271","article-title":"The value of a cross\u2010discipline team\u2010based approach for resection of renal cell carcinoma with IVC tumor thrombus: A report of a large, contemporary, single\u2010institution experience","volume":"118","author":"Master","year":"2018","journal-title":"J Surg Oncol"},{"key":"2026020208201138000_19.2.e270503.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-410X.2012.11174.x"},{"key":"2026020208201138000_19.2.e270503.5","doi-asserted-by":"publisher","DOI":"10.1177\/1756287215576443"},{"key":"2026020208201138000_19.2.e270503.6","doi-asserted-by":"publisher","DOI":"10.1053\/j.jvca.2013.04.002"},{"key":"2026020208201138000_19.2.e270503.7","doi-asserted-by":"crossref","first-page":"1372625","DOI":"10.3389\/fonc.2024.1372625","article-title":"Case report: Anesthetic management for removal of tumor thrombus in the inferior vena cava and pulmonary artery in renal cell carcinoma","volume":"14","author":"Chen","year":"2024","journal-title":"Front Oncol"},{"key":"2026020208201138000_19.2.e270503.8","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000542962","article-title":"Anesthetic Management of Renal Tumor with Level 3 Inferior Vena Cava Extension at a University Hospital in Vietnam: A Case Report","volume":"18","author":"Phan","year":"2025","journal-title":"Case Rep Oncol"},{"key":"2026020208201138000_19.2.e270503.9","article-title":"Management of Renal Cell Carcinoma With Intra-atrial Tumour Thrombus: A Case Report","volume":"15","author":"Alam","year":"2023","journal-title":"Cureus"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-270503","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T16:20:21Z","timestamp":1770049221000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-270503"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":9,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,2]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bcr-2025-270503"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-270503","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}