Renal tumors with inferior vena cava thrombus: case series highlighting surgical planning by thrombus level

Abstract Background Renal tumors with IVC thrombus extension form a major surgical challenge with variable surgical outcomes. It needs proper pre-operative preparation and a well-organized surgical team from different specialties. Case series We presented four patients with parenchymal renal tumors with IVC thrombus of different levels who underwent surgery at our institute from 2021 to 2025. All patients underwent radical nephrectomy and thrombectomy. Adequate blood products were prepared preoperatively. The operative approach was adapted according to thrombus extension, with techniques including vascular control, Pringle maneuver, and cardiopulmonary bypass when indicated. The operative time ranged from 5 to 10 h with no intraoperative mortality. During follow-up, tumor recurrence was observed in two patients. Conclusion Renal tumor thrombus requires a multidisciplinary team preparation. Adapting the surgical technique according to the thrombus level is critical to achieve a safe and effective outcome.