Mr. Sudama Dubey is a 50-year-old sole bread winner of the family. A Coal mine worker from Bardhaman, West Bengal was referred to us from Tata Memorial Centre, Mumbai for surgical intervention during COVID Pandemic.

He was passing blood with urine and on medical checkup found to have a tumor in one of the kidneys. He was evaluated at Tata Medical Centre in Mumbai and came to know that the tumor had spread beyond the kidney and going to one of the major blood vessels called Inferior Vena Cava which brings the whole blood from lower part of body to heart. The tumor was reaching in the part of Inferior vena Cava inside the liver and infiltrating the wall of inferior vena cava.

In this case, it was not easy to operate him as it is a very high-risk surgery and needed a surgical team of GI surgeon, Vascular surgeon and a Uro-Oncosurgeon long with support of cardiac unit and dialysis unit which is not easily available at a single center in most part of our country. Also, there was a chance of acquiring COVID-19 infection during hospital stay.

We re-evaluated Mr. Dubey and our tumor board decided to start immunotherapy before going for surgery so that the tumor size can be reduced and the surgery becomes easier. Mr. Dubey was feeling hopeless at that moment. After discussion and counseling with him, he agreed to the plan and we started immunotherapy.

After 3 months of immunotherapy the tumor size reduced. The tumor which was extending into the IVC inside the liver was now just touching the liver.

He was operated and Left Radical Nephrectomy with IVC thrombectomy with excision of a part of wall of IVC was done by a team of GI-surgeon, Vascular surgeon and Uro-Oncologist. We were able to completely remove the tumor along with kidney and tumor thrombus and the lymph glands.

Post-operatively, he recovered well and discharged after few days. Now he is under follow up checkups and completely leading his normal life.

It takes many hands to heal. Multimodal treatment and a great team make a lot of difference

Message from this story for all is

• Cancer of kidney has good outcome provided it is detected early.
• Any person having history of passage of blood in urine (even one drop) should not be ignored. Early detection of cancer makes it a curable disease.
• A state-of-the-art institution is required to manage this kind of cases where team of experts and advanced technology or facility are available.