Asian Journal of Research and Reports in Urology

Background and Aim: Renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus represents an advanced stage of disease and poses major surgical challenges. Level II thrombus can be managed surgically without cardiopulmonary bypass, but outcomes from low-resource centers remain underreported. This study aimed to evaluate surgical feasibility, perioperative safety, and medium-term survival outcomes of radical nephrectomy with IVC thrombectomy for Level II thrombus in a resource-limited tertiary care setting.

Methods: A prospective analysis was conducted on six patients with RCC and Mayo Clinic Level II IVC thrombus managed at our center. All underwent open radical nephrectomy with IVC thrombectomy through a Chevron incision. Preoperative data, intraoperative parameters (surgical time, IVC clamping time, blood transfusion needs), and postoperative complications (Clavien–Dindo classification) were recorded. Survival outcomes were assessed using Kaplan–Meier analysis over an 18-month follow-up.

Results: Mean surgical time was 320 minutes; mean IVC clamp time was 12.3 minutes. The average transfusion requirement was 2.6 units of whole blood. There was no perioperative mortality and only minor complications (Grade I–II). Median hospital stay was 8.5 days. Two deaths occurred at 5 and 7 months (metastatic disease). Kaplan–Meier survival was 83.3% at 5 months, 66.7% at 7 months, and remained stable through 18 months in the censored patients.

Conclusion: Radical nephrectomy with Level II IVC thrombectomy can be performed safely in resource-limited settings with experienced multidisciplinary teams, achieving zero perioperative mortality and durable medium-term survival in the majority of patients. These results provide valuable evidence to guide surgical decision-making and reinforce that high-quality outcomes are possible outside high-volume centers.