Renal Cell Carcinoma with IVC Thrombi; Current Concepts and Future Perspectives

The incidence of venous extension to the inferior vena cava (IVC) in renal cell carcinoma (RCC) is markedly increased recently mostly due to the advances in diagnostic modalities. Such vascular invasion implies a heightened biologic behavior and a surgical challenge during the course of treatment. In this study, we reviewed the classification guidelines, recent diagnostic tools and up-to-date therapeutic modalities for RCC with IVC tumor thrombi added to the prognostic significance regarding the pathologic nature of vascular invasion; cephalad extent of thrombi and any associated distant metastasis. Also, we are providing our suggestion regarding the use of angioscopy for removal of IVC thrombi in a relatively bloodless field without aggressive surgical manipulations or shunt techniques for maintenance of hemodynamic stability.