Surgical management of renal cell carcinoma invading the vena cava

Surgery remains the most effective treatment for renal cell carcinoma (RCC) invading the vena cava. Removal of tumor involving the vena cava or atrium may be challenging, but a thorough preoperative assessment and careful surgical technique have enhanced safety of resection and improved outcome. Preoperative imaging is essential for effective surgical intervention. Tumor extension into the vena cava does not adversely influence outcome in most reports. Characteristics of the primary tumor, including grade, perinephric fat invasion, lymph node involvement, and metastases, dictate outcome. Metastases are not an absolute contradiction to surgery, given the encouraging results with adjuvant immunotherapy. Nonetheless, improved methods for appropriate patient selection and new adjuvant therapies are needed to complement surgical intervention.