Innovations of surgical techniques for the management of inferior vena cava tumor thrombus of renal cell carcinoma.

Surgery for renal cell carcinoma with inferior vena cava thrombus is challenging. Cardiopulmonary bypass and deep hypothermic circulatory arrest significantly decreased the morbidity and mortality but associated with considerable postoperative complications. Debates still exist in one- or two-stage operations on which of the cardiac and urologic parts should be performed first. Modified maneuvers with main pulmonary artery clamping, vena cystoscope, transesophageal echocardiographic incorporation, and inferior vena cava interruptions are good for reduced perioperative morbidities. Surgical innovations have greatly facilitated the resection of renal cell carcinoma and inferior vena cava involvement. The advantages have been remarkable in less trauma, more cosmetic advantages, shorter hospital stay, and quicker recovery over the conventional open surgery with or without the use of bypass techniques. Such procedures have brought about improved long-term survivals. However, novel minimally invasive techniques such as robotic-assisted and hybrid approaches remain to gain further popularity in larger patient population. This article aims at a collection of the innovations of the surgical techniques in relation to the management of inferior vena cava tumor thrombus.