Cytoreductive Nephrectomy and Thrombectomy for Metastatic Renal Cell Carcinoma with Venous Tumor Thrombus: Experience from a High-Volume Center.

PURPOSE: For metastatic renal cell carcinoma (mRCC) with venous tumor thrombus (TT), the role of cytoreductive nephrectomy (CN) remains controversial, particularly in the targeted-immunotherapy era, and East-Asian data are limited. METHODS: This study retrospectively included 160 East-Asian patients with mRCC with TT who underwent CN and thrombectomy from January 2014 to January 2025. Overall survival (OS) was the primary endpoint. Kaplan-Meier and Cox regression analyses identified prognostic factors. Variables with a p‑value < 0.1 in the univariate analysis were entered into the multivariate analysis. A two‑sided p‑value < 0.05 was considered statistically significant. RESULTS: Median follow-up was 35 months; median OS was 41 months. Multivariate analysis identified four independent risk factors for poor OS: sarcomatoid differentiation (p < 0.001), serious postoperative complications (p < 0.001), rhabdoid differentiation (p = 0.004), and pathologic lymph node metastasis (p = 0.005). Mayo level was not significantly associated with OS. Robotic surgery demonstrated superior perioperative outcomes to open surgery, although baseline characteristics between the two groups were not comparable. CONCLUSIONS: Acceptable long-term oncologic outcomes are achievable when CN and thrombectomy are performed in carefully selected surgical patients with mRCC and venous TT. Sarcomatoid differentiation, rhabdoid differentiation, pathologic lymph node metastasis, and postoperative serious complications are independent predictors of poor prognosis. To obtain more reliable perioperative outcome data, robotic surgery should be compared with open surgery in larger patient populations. Multidisciplinary evaluation and centralization of care at high‑volume centers are strongly encouraged.