Outcomes of Radical Nephrectomy With Caval Tumour Thrombectomy Including a Novel Two-Stage Approach.
Daniel Crisafi1, Anne Hong1, Nathan Papa1
1Department of Urology, Austin Health, Melbourne, Australia.
ANZ Journal of Surgery
|December 1, 2025
Summary
Radical nephrectomy with inferior vena cava (IVC) tumor thrombectomy is a high-morbidity procedure for advanced renal cell carcinoma (RCC). Despite risks, it offers an effective treatment for otherwise fatal disease, with survival influenced by metastatic status.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Renal cell carcinoma (RCC) can involve the renal vein and inferior vena cava (IVC) in 10%-25% of cases.
- This necessitates complex surgical intervention, including radical nephrectomy and IVC tumor thrombectomy.
- Assessing perioperative outcomes and survival is crucial for managing advanced RCC.
Purpose of the Study:
- To evaluate the perioperative morbidity and survival outcomes.
- To examine the effectiveness of radical nephrectomy with IVC tumor thrombectomy.
- To analyze outcomes at a quaternary Australian institution.
Main Methods:
- Retrospective review of 39 patients undergoing nephrectomy with tumor thrombectomy (June 2012-September 2024).
- Analysis of overall survival (OS) using Kaplan-Meier plots and log-rank tests.
- Examination of recurrence-free survival (RFS) in patients without initial metastases.
Main Results:
- 15% in-hospital mortality and 36% experienced severe complications (Clavien-Dindo grade III-IV).
- Median OS was 57 months, significantly impacted by metastatic disease (p=0.003).
- Median RFS for M0 patients was 60 months.
Conclusions:
- Nephrectomy and IVC thrombectomy are associated with significant morbidity and mortality.
- This procedure remains an effective treatment for advanced, otherwise fatal RCC.
- Survival is strongly correlated with the absence of metastatic disease at diagnosis.
