Robot-assisted Radical Nephrectomy for Renal Cell Carcinoma With Versus Without Venous Tumor Thrombus

Robot-assisted radical nephrectomy (RARN) for renal cell carcinoma (RCC) with venous tumor thrombus (VTT) is technically demanding and direct comparisons with non-VTT cases in robotic cohorts are limited. We compared the perioperative and pathological outcomes of RARN between patients with and without VTT.

We retrospectively evaluated patients who underwent RARN for RCC at a single institution between April 2022 and August, 2025. The patients were divided into VTT and non-VTT groups. Baseline characteristics, perioperative outcomes, pathological findings, and postoperative complications were compared between the groups. Multivariate logistic regression analysis was performed to assess the factors associated with postoperative complications.

A total of 131 patients were included (30 with VTT and 101 without VTT). Patients in the VTT group had significantly larger tumors and more advanced clinical stages. The operative time tended to be longer, and the estimated blood loss was significantly higher in the VTT group; however, no patient in either group required perioperative blood transfusion. The length of hospital-stay and postoperative complication rates did not differ between groups. Pathological T stage was more advanced in the VTT group. In the multivariate analysis, VTT status was not independently associated with postoperative complications.

Although patients with VTT had more advanced disease and required more technically demanding procedures, RARN was associated with comparable perioperative outcomes in the selected cohort. These findings support the feasibility and perioperative safety of RARN in carefully selected patients with RCC with limited VTT.