Outcomes of Radical Nephrectomy With Caval Tumour Thrombectomy Including a Novel Two‐Stage Approach

Background Renal vein and caval tumour extension occurs in 10%–25% of patients with renal cell carcinoma. This study aims to examine perioperative morbidity and survival outcomes after radical nephrectomy with inferior vena cava tumour thrombectomy at a quaternary institution in Australia. Methods This was a retrospective review of nephrectomy with tumour thrombectomy cases between June 2012 and 2022 at a single centre, followed up until September 2024. Overall survival (OS) was visualised by Kaplan–Meier plots and comparisons between survival by presence of metastases, margin status, and thrombus level (I‐III vs. IV) were explored with the log‐rank test. Recurrence‐free survival (RFS) in patients without initial metastases was also examined. Results We identified 39 patients, 25 (64%) were male and the median (IQR) age was 64 years (55–69). Metastatic disease was present in 14 patients (36%). Nineteen (49%) had level IV (supradiaphragmatic) tumour thrombus involvement. Six patients (15%) died in hospital, including two intraoperative deaths. A further 14 (36%) experienced Clavien‐Dindo grade III or IV complications during their hospital stay. The median OS was 57 months (95% CI: 17–not reached). Excluding those who died in hospital, the median OS was 60 months (95% CI: 33–not reached). There was a significant difference in OS observed by the presence of metastatic disease ( p = 0.003), but not with margin status ( p = 0.35) or thrombus level ( p = 0.22). The median RFS for M0 patients was 60 months (95% CI: 8–not reached). Conclusion While associated with high morbidity and mortality, nephrectomy and caval thrombectomy remain an effective treatment option for otherwise fatal advanced RCC.