Tumor-informed ctDNA surveillance after radical nephrectomy and level IV IVC thrombectomy for clear cell renal cell carcinoma: Early detection of molecular residual disease

Renal cell carcinoma with level IV inferior vena cava tumor thrombus is rare and associated with high recurrence risk despite complete resection. We report an 80-year-old man who underwent radical nephrectomy and inferior vena cava thrombectomy with initial negative postoperative imaging. One year later, imaging findings were equivocal, but tumor-informed circulating tumor DNA was detectable, prompting early surgical resection of recurrent disease. Postoperatively, circulating tumor DNA became undetectable. This case highlights the potential role of tumor-informed circulating tumor DNA surveillance in detecting molecular residual disease and guiding management in high-risk renal cell carcinoma.