Renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a rare but challenging condition, occurring in approximately 4% to 10% of RCC cases. In the absence of metastases, radical surgery is the primary treatment option. While traditional open surgery has been standard, robotic-assisted techniques are gaining attention. We aim to share our experience and top technical tips from real-time recorded surgery.
We present a cohort of nine robotically performed cases from 2021 to 2024, involving five females and four males, aged 60 to 88 years. The cases included six right-sided and three left-sided tumors, ranging from 3.4 to 12 cm, with caval extension from 1 to 6 cm, causing dilation of 1.7 to 6 cm, and no caval wall invasion. Operative time varied from 3 to 6 hours, with estimated blood loss of 100 to 300 ml, and no on-table transfusions. Length of stay was 2 to 6 days, with one case classified as Clavien-Dindo 3 or higher due to a stroke. At the 3-month follow-up, none showed local residual or distant recurrence, with a mean drop in estimated glomerular filtration rate (eGFR) of 24% (0% to 52%).
Robotic-assisted surgery for RCC with IVC thrombus is safe and effective in well-selected cases.