Presurgical immune-oncology/tyrosine kinase inhibitor combination therapy for renal cell carcinoma with a vena cava tumor thrombus: a single-institution case series.

Background: Although current guidelines recommend administering adjuvant immunotherapy following resection of advanced primary renal cell carcinoma (RCC), the clinical benefit of presurgical immunotherapy for patients with RCC remains uncertain. Case Description: We conducted a retrospective analysis of five patients diagnosed with RCC who developed inferior vena cava (IVC) tumor thrombus and were treated with radical nephrectomy following combined immunotherapy with a tyrosine kinase inhibitor. The median follow-up after nephrectomy was 23 months (range, 19-30 months). In all cases, the size of the IVC tumor thrombus decreased, and three of the cases demonstrated a decrease in the tumor thrombus level. Surgical margins were negative in all cases, and none of the patients experienced any major intraoperative complications. However, adhesions were encountered at the operative sites during surgery in all cases. One patient required a lymphatic intervention due to abdominal lymphatic leakage (Clavien IIIa) within 90 days after operation. Our case series demonstrated a median progression-free survival (PFS) of 11 months [95% confidence interval (CI)]: 5.5-22.5 months). No patient died during the follow-up period. Conclusions: Presurgical therapy combined with immunotherapy and tyrosine kinase inhibitors warrants consideration. Nevertheless, surgeons should be mindful of the difficulties that may arise beyond the clinical stage.