What does this research mean for the field?

Increasing Mayo classification levels (I to III) in renal cell carcinoma with infradiaphragmatic inferior vena cava thrombus are significantly associated with greater surgical complexity, higher perioperative morbidity and mortality, and decreased overall survival. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate perioperative outcomes and long-term survival in renal cell carcinoma patients with IVC tumour thrombus based on Mayo classification levels.

March 5, 2026Open Access

Renal Cell Carcinoma with Infradiaphragmatic IVC Tumour Thrombus: Prognostic Value of the Mayo Classification

Key Result

Increasing Mayo levels I to III in RCC with infradiaphragmatic IVC thrombus associate with longer surgery, higher blood loss, morbidity, mortality, and decreased survival (120.8 to 7.7 months).

Key Points

To evaluate perioperative outcomes and long-term survival in renal cell carcinoma patients with IVC tumour thrombus based on Mayo classification levels.
10-year retrospective case series of 33 renal cell carcinoma patients
Patients were stratified by Mayo classification levels I (n=14), II (n=13), and III (n=6)
Comparison of perioperative outcomes and survival across the three Mayo levels
Higher Mayo classification was associated with longer operative duration and increased blood loss
Postoperative morbidity and mortality increased with higher Mayo levels
Median overall survival decreased from 120.8 months for level I to 7.7 months for level III

Structured PICO

Does the Mayo Clinic classification level (I-III) predict perioperative outcomes and long-term survival in patients with renal cell carcinoma and infradiaphragmatic IVC tumour thrombus?

Population

33 consecutive patients with renal cell carcinoma (T3b RCC) and tumour thrombus extension into the infradiaphragmatic portion of the inferior vena cava undergoing radical nephrectomy and IVC thrombectomy.

Intervention

Mayo Clinic classification levels II (n=13) and III (n=6) for infradiaphragmatic IVC thrombus.

Comparator

Mayo Clinic classification level I (n=14).

Outcome

Perioperative outcomes (operative duration, intraoperative blood loss, postoperative morbidity, and mortality) and long-term overall survival.hard clinical

The Mayo Clinic classification for infradiaphragmatic IVC thrombus in renal cell carcinoma strongly correlates with surgical complexity, perioperative morbidity/mortality, and long-term survival, validating its prognostic utility.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

To assess the differences in perioperative outcomes, surgical complexity, and long-term survival for patients with renal cell carcinoma and tumour thrombus extension into the infradiaphragmatic portion of the inferior vena cava, stratified by the Mayo Clinic classification levels I–III. This was a 10-year, single-institution retrospective case series of 33 consecutive RCC patients undergoing radical nephrectomy and IVC thrombectomy. Patients were stratified into Mayo levels I (n = 14), II (n = 13), and III (n = 6). Perioperative outcomes and survival were compared across the three levels. Increasing Mayo level was significantly associated with longer operative duration (p = 0.0159), and higher intraoperative blood loss (p = 0.0171). Postoperative morbidity (p = 0.0037) and mortality (p = 0.0394) also increased with higher levels. Survival analysis demonstrated significant differences among the groups, with median overall survival of 120.8 months for Mayo level I, 33.8 months for Mayo level II, and 7.7 months for Mayo level III. The Mayo Clinic classification of the infradiaphragmatic IVC thrombus (Levels I–III) correlates with increasing surgical complexity and decreasing survival. This subclassification of T3b renal cell carcinoma patients is crucial for guiding surgical strategy and predicting prognosis.

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