ArticleFrontiers in surgery2025
Radical nephrectomy with inferior vena cava tumor thrombectomy in Mayo III-IV renal cell carcinoma: a retrospective single-center study.
Article in Frontiers in surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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Who cites it
3 citing papers in PubMed.
- Modern management of locally advanced renal cancers with inferior vena cava thrombus.World journal of urology · 2026Review
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10 authors.
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Abstract
Background: Tumor thrombus extending into the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC), particularly at Mayo levels III and IV, presents a major surgical challenge. Although systemic treatments are evolving, surgery remains the mainstay of management. The role of cardiopulmonary bypass (CPB) in this setting is not clearly defined. Methods: We retrospectively analyzed 20 patients with RCC and Mayo level III-IV IVC tumor thrombus who underwent radical nephrectomy with IVC thrombectomy at our center between 2017 and 2024. Preoperative workup included MRI, contrast-enhanced CT, and transthoracic/transesophageal echocardiography. CPB was used selectively in five patients with tumor extension into and adherence to the right atrium. Postoperative complications were classified using the Clavien-Dindo system. Survival was assessed with Kaplan-Meier analysis and Cox regression. Results: Median age was 61 years (IQR 51-72), and 70% were male. Level IV thrombus was present in 60% of patients, and 40% had distant metastases. Median operative time was 370 minutes and median blood loss was 2,500 mL. Postoperative complications occurred in 20% of patients, with one in-hospital death (5%). Median hospital stay was 11 days. The 1-, 3-, and 5-year overall survival rates were 66.7%, 41.6%, and 34.6%, respectively. Distant metastases were associated with lower survival (HR 2.48; Conclusion: Radical nephrectomy with IVC thrombectomy in patients with advanced tumor thrombus can be performed safely with good long-term outcomes in selected cases. Careful preoperative imaging, intraoperative echocardiography, and the selective use of CPB are key to minimizing risks. These findings support a tailored surgical approach based on thrombus level and clinical condition. Further prospective studies are needed to refine surgical indications and clarify the role of systemic therapy.
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