BACKGROUND: Renal cell carcinoma (RCC) is a prevalent kidney malignancy known for its aggressive nature and potential to extend into the renal vein or inferior vena cava (IVC), affecting patient prognosis and treatment strategies. OBJECTIVE: To assess the long-term outcomes and effectiveness of radical nephrectomy with IVC thrombectomy in patients with RCC presenting with level I-IV IVC thrombus. METHODS: A retrospective analysis was conducted on 164 adult patients treated for RCC with IVC thrombectomy at a tertiary care center from January 2004 to December 2023. Data including demographics, clinical characteristics, tumor specifics, surgical details, complications, and survival rates were meticulously reviewed. RESULTS: Among the patients, the mean age was 63.7 years, predominantly male (69.5%). The histological profile showed a majority of clear cell carcinoma (95.7%), with most tumors located on the right side (71.3%). Thrombus levels were distributed across I-IV, with 41 (25%) patients presenting with level I, 33 (20.1%) with level II, 55 (33.5%) with level III, and 35 (21.4%) with level IV thrombi. The mean operation time and blood loss increased with thrombus level. Perioperative complications were recorded in 57.3% of patients, and over half of the patients experienced disease recurrence (54.9%). The overall 5-year survival rate stood at 42.1%, with notably better survival in patients with level I thrombi. CONCLUSION: Radical nephrectomy with IVC thrombectomy provides a potential for long-term control in patients with RCC and IVC thrombus, although it is associated with significant morbidity. Multidisciplinary care and expert surgical intervention are crucial for improving patient outcomes. The variability in survival rates across thrombus levels underscores the need for individualized treatment approaches.

Department of Cardiac Surgery University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Urology University Hospital Hradec Kralove Sokolska 581 Hradec Kralove 500 05 Czech Republic

Faculty of Medicine in Hradec Kralove Charles University Prague Czech Republic

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Ferlay J, Colombet M, Soerjomataram I, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018. Eur J Cancer. 2018;103:356–87. 10.1016/j.ejca.2018.07.005. PubMed

Capitanio U, Bensalah K, Bex A, et al. Epidemiology of Renal Cell Carcinoma. Eur Urol. 2019;75(1):74–84. 10.1016/j.eururo.2018.08.036. PubMed PMC

Bukavina L, Bensalah K, Bray F, et al. Epidemiology of Renal Cell Carcinoma: 2022 Update. Eur Urol. 2022;82(5):529–42. 10.1016/j.eururo.2022.08.019. PubMed

Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update. Eur Urol. 2022;82(4):399–410. 10.1016/j.eururo.2022.03.006. PubMed

Nouh MA, Inui M, Kakehi Y. Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives. Clin Med Oncol. 2008;2:247–56. 10.4137/cmo.s464. PubMed PMC

Haidar GM, Hicks TD, El-Sayed HF, Davies MG. Treatment options and outcomes for caval thrombectomy and resection for renal cell carcinoma. J Vasc Surg Venous Lymphat Disord. 2017;5(3):430–6. 10.1016/j.jvsv.2016.12.011. PubMed

Reese AC, Whitson JM, Meng MV. Natural history of untreated renal cell carcinoma with venous tumor thrombus. Urol Oncol Semin Orig Investig. 2013;31(7):1305–9. 10.1016/j.urolonc.2011.12.006. PubMed

Blute ML, Leibovich BC, Lohse CM, Cheville JC, Zincke H. The Mayo Clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus. BJU Int. 2004;94(1):33–41. 10.1111/j.1464-410X.2004.04897.x. PubMed

Zacek P, Brodak M, Gofus J, et al. Renal cell carcinoma with intracardiac tumor thrombus extension: Radical surgery yields 2 years of postoperative survival in a single-center study over a period of 30 years. Front Oncol. 2023;13. doi:10.3389/fonc.2023.1137804 PubMed PMC

Faria-Costa G, Freitas R, Braga I, et al. Renal Cell Carcinoma with Venous Tumor Thrombus: 15 Years of Experience in an Oncology Center. J Clin Med. 2024;13(20):6260. 10.3390/jcm13206260. PubMed PMC

Kakoti S, Jena R, Sureka SK, Srivastava A, Mandhani A, Singh UP. Experience with management of renal cell carcinoma with inferior vena cava/right atrial tumor thrombus. Indian J Urol. 2021;37(3):234–40. 10.4103/iju.IJU_13_21. PubMed PMC

Gamboa-Hoil SI, Martínez-Cornelio A, Hernández-Toríz N, Riera-Kinkel C. Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery. Curr Heal Sci J. 2021;47(1):96–100. 10.12865/CHSJ.47.01.15. PubMed PMC

Wang T, Huang Y, Yang L, et al. Histological features suggestive of survival in patients with renal cell carcinoma and tumor thrombus: A single-center experience. Front Oncol. 2022;12. 10.3389/fonc.2022.980564. PubMed PMC

Klatte T, Pantuck AJ, Riggs SB, et al. Prognostic Factors for Renal Cell Carcinoma With Tumor Thrombus Extension. J Urol. 2007;178(4):1189–95. 10.1016/j.juro.2007.05.134. PubMed

Ciancio G, Manoharan M, Katkoori D, De Los Santos R, Soloway MS. Long-term Survival in Patients Undergoing Radical Nephrectomy and Inferior Vena Cava Thrombectomy: Single-Center Experience. Eur Urol. 2010;57(4):667–72. 10.1016/j.eururo.2009.06.009. PubMed

Westesson KE, Klink JC, Rabets JC, et al. Surgical Outcomes After Cytoreductive Nephrectomy With Inferior Vena Cava Thrombectomy. Urology. 2014;84(6):1414–9. 10.1016/j.urology.2014.05.078. PubMed

Khene Z-E, Bhanvadia R, Tachibana I, et al. Surgical Outcomes of Radical Nephrectomy and Inferior Vena Cava Thrombectomy Following Preoperative Systemic Immunotherapy: A Propensity Score Analysis. Clin Genitourin Cancer. 2025;23(2):102307. 10.1016/j.clgc.2025.102307. PubMed

Yap SA, Horovitz D, Alibhai SMH, Abouassaly R, Timilshina N, Finelli A. Predictors of early mortality after radical nephrectomy with renal vein or inferior vena cava thrombectomy– a population-based study. BJU Int. 2012;110(9):1283–8. 10.1111/j.1464-410X.2012.11125.x. PubMed

Pyrgidis N, Schulz GB, Stief CG, et al. Perioperative Outcomes After Radical Nephrectomy with Inferior Vena Cava Thrombectomy. Cancers (Basel). 2025;17(7):1083. 10.3390/cancers17071083. PubMed PMC

Lawindy SM, Kurian T, Kim T, et al. Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int. 2012;110(7):926–39. 10.1111/j.1464-410X.2012.11174.x. PubMed

Masic S, Smaldone MC. Robotic renal surgery for renal cell carcinoma with inferior vena cava thrombus. Transl Androl Urol. 2021;10(5):2195–8. 10.21037/tau.2019.06.15. PubMed PMC

Ramirez D, Maurice MJ, Cohen B, Krishnamurthi V, Haber G-P. Robotic Level III IVC Tumor Thrombectomy: Duplicating the Open Approach. Urology. 2016;90:204–7. 10.1016/j.urology.2016.01.011. PubMed