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Images and intraoperative position in Case 1.
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Examination of abdominal images revealed a 7-cm invasive right renal cell carcinoma and tumor thrombus spreading deeply inside the vena cava (Fig. 1a, b). The HBP surgeon selected incisional access by right oblique thoracolaparotomy to expose the right side of the vena cava infiltrated by tumor thrombi for thrombectomy, and dissected between the liver and kidney (Fig. 1c).
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Images in Case 2.
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A 24-year-old man had undergone resection of left testicular tumor (mixed germ-cell tumor); however, the tumor relapsed as a 15 cm retroperitoneal node metastasis around the left kidney with widely infiltrated tumor thrombi into the right atrium via the left renal vein and vena cava (Fig. 2a). At 8 months after the operation, remnant liver metastases in segments 2 and 7 were partially resected using the laparoscopic approach by HBP surgeons (Fig. 2b, c).