Robot-Assisted Versus Open Nephrectomy with Inferior Vena Cava Thrombectomy in Renal Cell Carcinoma: Current Evidence and Surgical Trends

Background/Objectives: Renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT) is a rare and surgically complex condition traditionally managed with open nephrectomy and thrombectomy. Robot-assisted approaches are increasingly used in selected patients, but their comparative perioperative and oncological value remains uncertain. This systematic review aimed to summarize current evidence comparing robot-assisted and open nephrectomy with IVC thrombectomy in RCC. Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed according to PRISMA guidelines. Original clinical studies reporting perioperative or oncological outcomes of nephrectomy with IVC thrombectomy were included. Owing to substantial heterogeneity, a qualitative synthesis was performed. Results: Thirteen studies were included. Robot-assisted surgery was associated with lower estimated blood loss, reduced transfusion rates, and shorter hospital stay, although operative time was generally longer. Complication rates and oncological outcomes were broadly comparable between approaches. Robotic cohorts were typically highly selected and included mainly patients with lower-level thrombi, limited tumor burden, and procedures performed in high-volume centers. Conclusions: Robot-assisted nephrectomy with IVC thrombectomy appears feasible and safe in carefully selected patients and may improve perioperative outcomes without compromising oncological efficacy. However, open surgery remains essential for complex high-level thrombi. Tumor thrombus level, tumor burden, and institutional expertise should guide surgical approach selection.