A 55-year-old man presents with haematuria, right loin pain, and a palpable right flank mass — the classic triad. CT urography reveals a 7 cm heterogeneous right renal mass with renal vein thrombus extending into the IVC below the hepatic veins (Neves stage II IVC thrombus). The recommended surgical procedure is:
- A Partial nephrectomy
- B Ablative therapy (RFA/cryoablation)
- C Right radical nephrectomy with IVC thrombectomy ✓
- D Sunitinib targeted therapy as first-line treatment
Correct answer: C. Right radical nephrectomy with IVC thrombectomy
Explanation
A 7 cm renal cell carcinoma with IVC thrombus below the hepatic veins (Neves/Novick Stage II) is potentially curable with surgery. Radical nephrectomy combined with IVC thrombectomy (infrahepatic approach with vascular control above and below the thrombus) is the standard curative operation. The presence of IVC thrombus alone, without distant metastases, is not a contraindication to surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.