Recurrent Renal Tumor Thrombus in Inferior Vena Cava After Surgery: Surgical Management and Clinicopathological Features from a Large Chinese Center

Background: To summarize the surgical technique and clinicopathological features of recurrent renal tumor thrombus in inferior vena cava (IVC) after surgery.Methods: We retrospectively analyzed the clinicopathological data of nine patients with recurrent renal tumor thrombus in IVC after surgery, who were admitted to Peking University Third Hospital between November 2015 and March 2021. Results: Among the nine patients, six patients (66.7%) developed recurrent tumor thrombus in the IVC after radical nephrectomy; two cases (22.2%) were recurrent tumor thrombus in the IVC after partial nephrectomy. One patient (11.1%) underwent partial nephrectomy first and radical nephrectomy for the second time. The recurrence of tumor thrombus in the IVC occurred after the operation. All the nine patients underwent open surgery for IVC thrombectomy. Eight patients (88.9 %) were operated smoothly. Among these eight patients, six patients (75%) underwent IVC segmental resection, and two patients (25%) underwent IVC thrombectomy. Another patient underwent IVC tumor thrombus exclusion. Median operative time was 380 (IQR: 338.5–540.5) min. Median estimated intraoperative blood loss was 1200 (IQR: 600–2250) ml. According to the modified Clavien classification system, one patient had grade I complications, three patients had grade II complications, and one patient had grade IVa complications. During a 20-months (range, 2-58 months) follow-up, tumor-specific death occurred in three patients and distant metastasis occurred in six patients.Conclusions: The operation of recurrent renal tumor thrombus in IVC after surgery is difficult. For patients with high-risk renal cell carcinoma, more close follow-up should be conducted after operation.