Renal cell carcinoma with inferior vena cava thrombus: did we make progress in oncologic outcomes and complications?

Abstract

Purpose of reviewSurgery for renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (TT) remains one of the most complex surgeries performed with high rates of associated complications and perioperative mortality. Surgical techniques and neoadjuvant therapies have an important role to play in improving outcomes. This review provides a narrative analysis of recent literature on patients with RCC and TT. Recent findingsSeveral imaging techniques are emerging that may improve diagnostic staging of tumor thrombus level. Robotic approaches to surgical resection for all thrombi levels is feasible and safe, while longer term outcomes for higher level thrombi continues to mature. Early data on neoadjuvant immunotherapy and radiotherapy have shown improvements in complication rates and intermediate term oncologic outcomes. SummaryData suggests that neoadjuvant therapies and minimally invasive techniques may improve outcomes in patients undergoing surgical resection for RCC with tumor thrombus. Larger multiinstitutional series are needed to confirm the benefit of these techniques as well as the durable long term oncologic outcomes.

A novel technique for proximal inferior vena cava control during tumor thrombectomy using the COBRA-OS balloon

“…However, perioperative complication rate increases with higher level of tumor thrombus, ranging from 12% to 47%. 5 The mortality rate following radical nephrectomy and thrombus removal ranges from 5% to 12.5%, depending on the concurrent conditions and tumor thrombus features. 1 According to the rarity and complexity of the disease, better surgical results are likely to be achieved in high-volume hospitals.…”