Multidisciplinary surgical treatment of clear-cell renal carcinoma with inferior vena cava tumor thrombus level III and IV: our experience during the past decade

Patients with non-metastatic, stage T3 clear-cell renal cell cancer present a clinical challenge for urologists. The extent of tumor thrombus in inferior vena cava is the primary determinant of surgical procedure complexity. Level III and IV thrombi require the use of cardiopulmonary bypass and hypothermic arrest. Careful preoperative planning and a multidisciplinary approach are mandatory. In this paper, we report outcomes of 12 patients who were surgically treated in our center. The 29 months overall survival for all patients was 69%, while three patients died during follow-up. Of nine surviving patients, six are currently disease-free, whereas three had disease progression. Our study showed that carefully selected patients with clear-cell renal cell carcinoma with inferior vena cava tumor thrombus level III and IV could be successfully treated with an aggressive surgical approach.