Impact of Multidisciplinary Surgical Team Involvement on Outcomes of Radical Nephrectomy with IVC Thrombectomy

Introduction:Inferior vena cava (IVC) tumor thrombectomy is a complex operation, often requiring a multidisciplinary surgical team (MDT).This study evaluates the characteristics and outcomes of radical nephrectomy with level II or greater IVC tumor thrombectomy with MDT involvement, addressing the limited data on specific MDT subspecialty outcomes. Methods:We reviewed patients who underwent radical nephrectomy with level II or greater IVC tumor thrombectomy from 2015-2024 at our tertiary care center.Patients were grouped by MDT involvement (MDT vs. no MDT), MDT subspecialty (vascular, liver transplant, or surgical oncology), and number of subspecialties (<3 teams vs. 3 teams).Baseline characteristics, intraoperative data, and postoperative outcomes were compared.Results: Of 62 IVC tumor thrombectomy cases, 53 (85%) involved surgical MDTs (vascular surgery 26%, liver transplant 70%, surgical oncology 4%), while urology alone handled 9 (15%).Seventeen (27%) cases involved 3 surgical specialties.MDT involvement correlated with higher tumor thrombus levels, increased intraoperative blood transfusions, and more postoperative complications (p<0.05).MDT involvement, regardless of team size or specialty, did not affect length of stay, ICU stay, time to baseline, or discharge to rehabilitation/skilled nursing. Conclusion:Surgical MDTs play an essential role in managing complex IVC tumor thrombectomy cases, especially with higher level tumor thrombus.MDT involvement reflects operative complexity and is associated with higher complication rates.However, there is no difference in postoperative outcomes when comparing use of MDT or MDT subspecialty.These findings support the use of MDTs and tailoring MDT composition to the characteristics of the case.