Multidisciplinary Surgical Management of Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus: Perioperative...

Introduction Renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus occurs in a minority of cases but carries important prognostic implications, underscoring the need for timely and multidisciplinary management. Despite significant perioperative risks and surgical complexity, radical nephrectomy with IVC thrombectomy remains the standard treatment. A structured, multidisciplinary preoperative approach has been reported to improve outcomes. This study aims to evaluate the multidisciplinary team (MDT) surgical approach in the management of RCC with IVC thrombus and its impact on clinical outcomes. Methods This retrospective study included all adult patients who underwent radical nephrectomy with IVC thrombectomy in the Uro-Oncology Unit between January 2012 and February 2024. All cases were managed by the surgical MDT following a comprehensive preoperative review. Assessed outcomes included 30-day mortality, operative time, blood loss, perioperative complications, and oncological outcomes. Results Fourteen patients (mean age: 52.1 ± 9.8 years; 92.86% male) were included. Most had a Mayo level II thrombus. The 30-day mortality rate was 0%, and Clavien-Dindo class III-IV complications occurred in two patients. The mean operative time was 360 ± 121.2 minutes, and the median intraoperative blood loss was 3000 mL. No significant differences were observed in operative time (p = 0.31) or blood loss (p = 0.55) between lower and higher thrombus levels. The median hospital and ICU stays were 12 and six days, respectively. Over a median follow-up of 19.5 months, the overall survival (OS) rate was 78.57%, and cancer-specific survival (CSS) was 92.86%. Although OS was lower in patients with metastasis, the difference was not statistically significant. Eight patients developed new metastases during follow-up. Conclusion The surgical MDT approach in the management of RCC with IVC tumor thrombus was associated with improved perioperative outcomes. These findings highlight the potential benefits of MDT involvement in managing this complex condition and support further investigation in larger, comparative studies.