Inferior vena cavectomy for nonexcisable Wilms' tumor thrombus

Wilms' tumor with tumor extension into the vena cava is a not uncommon variant of tumor presentation. Typically, this extension is nonadherent to the endothelium and readily lends itself to removal either before or after chemotherapy. This case illustrates an unusual variant in which the tumor within the cava was tightly adherent to the venous wall and required the complete excision of the vena cava, left renal vein, and a portion of the iliac system.