Mysuru, Oct. 21- For months, 52-year-old Veerappa (name changed) had been living with unexplained weight loss and fatigue. He was already living with hypertension and chronic lung disease. Although these new symptoms added to his concerns, he had not expected the symptoms were due to a life-threatening massive kidney tumour, which was diagnosed at Manipal Hospital in Mysuru.

Diagnosis and treatment

Veerappa consulted Dr. Kiran Kumar, Visiting Consultant – Urology, at Manipal Hospital and was recommended CT and MRI scans. The scans revealed a giant 20x16cm cancerous tumour (renal cell carcinoma) in his right kidney, weighing nearly 2 kilograms.

The tumour had extended into the inferior vena cava (IVC) — the body’s main vein carrying blood back to the heart. At its thickest, the tumour measured 12x4x16cm inside the vein, creating a life-threatening situation where even the smallest disturbance could send tumour fragments into the heart or lungs.

Explaining the complexity of the case, Dr. T.P. Dinesh Kumar, Consultant – Urology, stated, “Renal cell carcinoma is the most common kidney cancer in adults. But they do not show any symptoms in early stages and are hence often diagnosed late. In rare instances, as in this case, cancer grows into the inferior vena cava, one of the most vital blood vessels in the body making surgical removal of tumour extremely challenging.”

A team of multidisciplinary experts at Manipal Hospital, Mysuru, who rose up to the challenge included: Dr. Kiran Kumar, Visiting Consultant – Urology, Dr. T.P. Dinesh Kumar, Consultant – Urology, Dr. Upendra Shenoy, Consultant – Cardiothoracic and Vascular Surgery, Dr. H. Vasudev Pai, Consultant – Surgical Gastroenterology, Dr. K. Mahadeva, Consultant – ICU and Critical Care, Dr. Nischal Molekeri and Dr. P.K. Balasubramanyam, Consultants – Anaesthesiology.

Inside the operating theatre, the hospital’s advanced infrastructure was put to test. A transesophageal echocardiogram (a camera-fitted probe that scans the chest cavity from inside the food pipe for real-time monitoring) was deployed to track the heart and ensure the tumour hadn’t spread higher.

A heart-lung bypass machine was kept on standby to take over circulation in case the heart or lung was compromised. Six units of fresh frozen plasma and platelets were readied to counter massive bleeding, an expected real risk in such a surgery.

For three-and-a-half hours, the team worked in unison. While the Urologists removed the tumour, the CTVS surgeon safeguarded the inferior vena cava by delicately clamping and removing the thrombus (tumour clot inside the vein), the gastroenterologists mobilised and flipped the liver helping better access for complete tumour removal and the anaesthetist ensured the patient’s stability throughout the procedure.

“Operating on the vena cava is like balancing on a razor’s edge. Any minute error would mean uncontrolled bleeding or pushing tumour into lung or heart, which could be life-threatening. The hospital’s advanced monitoring technology, surgical infrastructure and a coordinated team that anticipated every risk and was prepared with a solution, led to successful surgery,” said Dr. Upendra Shenoy.

Following the surgery, Veerappa was shifted to the ICU for monitoring under the care and guidance of ICU and Critical Care expert. He was placed on a ventilator for six hours and closely monitored. Within a day, he was breathing on his own and was shifted to ward. By day two, he resumed oral intake and on day-6, he walked out of the hospital tumour-free.