When Renal Cell Carcinoma (RCC) invades the veins, the stakes and the surgical challenges rise. Are you prepared? In this episode, Dr. Vidit Sharma (Mayo Clinic) joins guest host Dr. Daniel Roberson to review Renal Cell Carcinoma (RCC) with Venous Tumor Thrombus (VTT), seen in 4 to 10% of cases. They review Mayo level classification and how CT and MRI venography guide surgical planning by defining thrombus extent and IVC involvement.

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Timestamps

00:00 - Introduction
03:03 - What is a Venous Tumor Thrombus?
12:32 - Presentation and Workup
31:49 - Preoperative Considerations
40:26 - Building the Dream Team
46:06 - Preop Counseling and Risks
51:24 - The Operation
01:31:01 - Outcomes and Adjuvant Immunotherapy
01:36:40 - Future Neoadjuvant Shrinkage
01:39:40 - Final Takeaways

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More about this episode

They also cover key management decisions, including when anticoagulation is appropriate and why embolic urgency is often overestimated. Dr. Sharma highlights the importance of experienced multidisciplinary teams, reviews surgical considerations across thrombus levels, and discusses outcomes, including risk stratification with the TeNNiS model and evolving roles for systemic therapy.

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Resources

Outcomes for patients with renal tumors and venous tumor thrombus
https://www.mayoclinic.org/medical-professionals/urology/news/outcomes-for-patients-with-renal-tumors-and-venous-tumor-thrombus/mac-20570379

TeNNiS Score
https://www.goldjournal.net/article/S0090-4295(26)00078-6/fulltext

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