Abstract
Relevance: Patients with a solitary kidney and end-stage chronic kidney disease (ESCKD) represent a high-risk group in urologic oncology. Impaired renal function limits the possibilities of radical treatment and increases the risk of postoperative complications. An additional challenge is tumor invasion into the inferior vena cava (IVC). Although venous invasion occurs in 4-10% of patients with renal cell carcinoma, its combination with a solitary kidney and end-stage CKD is extremely rare in the literature. The present case demonstrates the possibility of successful nephroureterectomy with resection of the IVC wall in a patient with a severely unfavorable anatomical and functional situation. The study aimed to demonstrate the features of nephroureterectomy with inferior vena cava wall resection in a patient with a solitary kidney and end-stage chronic kidney disease, and to evaluate surgical risks, the effectiveness of a multidisciplinary approach, and the clinical outcome of the intervention. Methods: We present a clinical case of a patient with a malignant tumor of a solitary kidney with IVC invasion, ESCKD, and severe anemia. Detailed preoperative planning and multidisciplinary discussion of the surgical approach were conducted. Nephroureterectomy with resection of the IVC wall was performed. The postoperative period was complicated by pneumonia and pulmonary hypertension; the patient required renal replacement therapy (hemodialysis), hemodynamic monitoring, and prophylaxis of thromboembolic complications. Results: The surgery was completed successfully, the patient stabilized, and vital signs were compensated. Morphological examination confirmed papillary renal cell carcinoma, Grade 3, with lymphovascular invasion and IVC wall involvement, indicating a high risk of disease progression. At the end of follow-up, the patient’s condition was stable, requiring further dynamic monitoring and oncological management. Conclusion: This clinical case demonstrates that nephroureterectomy with IVC wall resection can be successfully performed in a patient with a solitary kidney and ESCKD, even in the presence of severe anemia and comorbidities, when careful preoperative planning and a multidisciplinary approach are applied. Surgical intervention remains the only effective method for prolonging life, emphasizing the need for strict postoperative monitoring and comprehensive patient management.