Perioperative Management Considerations in Nephrectomy with Inferior Vena Cava Thrombectomy in Patients with Renal Cell Carcinoma

Renal cell carcinoma is one of the most common oncourological malignancies and is associated with high mortality. Approximately 120,000 new cases of renal cell carcinoma are diagnosed worldwide each year, accounting for nearly 2% of the global cancer incidence. Tumor thrombosis of the inferior vena cava develops in 25-30% of cases and represents a life-threatening condition. According to current clinical guidelines, nephrectomy with thrombectomy is indicated in these patients as a radical surgical procedure or as a cytoreductive procedure within a multimodal treatment strategy. Analysis of surgical outcomes and perioperative management in patients with renal cancer complicated by “high-level” tumor thrombosis of levels III and IV (according to the Mayo Clinic classification) is critically important for improving treatment outcomes in this challenging patient population. The patient’s initial general condition (tumor-related intoxication, anemia, hyperazotemia, venous thrombosis of the lower extremities, along with comorbidities) and the extent of surgical intervention determine a high risk of complications (up to 93%) and in-hospital mortality (up to 10%). Preoperative risk assessment and careful preoperative preparation are essential for the safe surgical intervention and early rehabilitation. Currently, there are no universally accepted management algorithms for patients with tumor thrombosis of the inferior vena cava, and existing recommendations are largely general and do not consider the patient’s clinical condition or the specifics of the surgical intervention. The review aims to integrate current data on the pathophysiological features of the disease, perioperative complications, methods for their prevention and treatment in order to develop individualized approaches to patient management.