{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T15:11:41Z","timestamp":1788016301570,"version":"build-2784847793"},"reference-count":46,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background\/Objectives: Renal cell carcinoma (RCC) with inferior vena cava tumor thrombus (IVCTT) is a rare and surgically complex condition traditionally managed with open nephrectomy and thrombectomy. Robot-assisted approaches are increasingly used in selected patients, but their comparative perioperative and oncological value remains uncertain. This systematic review aimed to summarize current evidence comparing robot-assisted and open nephrectomy with IVC thrombectomy in RCC. Methods: A systematic search of PubMed, Scopus, Web of Science, and Cochrane Library was performed according to PRISMA guidelines. Original clinical studies reporting perioperative or oncological outcomes of nephrectomy with IVC thrombectomy were included. Owing to substantial heterogeneity, a qualitative synthesis was performed. Results: Thirteen studies were included. Robot-assisted surgery was associated with lower estimated blood loss, reduced transfusion rates, and shorter hospital stay, although operative time was generally longer. Complication rates and oncological outcomes were broadly comparable between approaches. Robotic cohorts were typically highly selected and included mainly patients with lower-level thrombi, limited tumor burden, and procedures performed in high-volume centers. Conclusions: Robot-assisted nephrectomy with IVC thrombectomy appears feasible and safe in carefully selected patients and may improve perioperative outcomes without compromising oncological efficacy. However, open surgery remains essential for complex high-level thrombi. Tumor thrombus level, tumor burden, and institutional expertise should guide surgical approach selection.<\/jats:p>","DOI":"10.3390\/cancers18142251","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:12:53Z","timestamp":1784023973000},"page":"2251","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Robot-Assisted Versus Open Nephrectomy with Inferior Vena Cava Thrombectomy in Renal Cell Carcinoma: Current Evidence and Surgical Trends"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4336-0773","authenticated-orcid":false,"given":"Zuzanna","family":"Korbecka","sequence":"first","affiliation":[{"name":"Department of General, Vascular and Transplant Surgery, Medical University of Silesia, St. Francuska 20-24, 40-064 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5495-2969","authenticated-orcid":false,"given":"Beata","family":"Jab\u0142o\u0144ska","sequence":"additional","affiliation":[{"name":"Department of Digestive Tract Surgery, Medical University of Silesia, St. Medyk\u00f3w 14, 40-753 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3079-0168","authenticated-orcid":false,"given":"Robert","family":"Kr\u00f3l","sequence":"additional","affiliation":[{"name":"Department of General, Vascular and Transplant Surgery, Medical University of Silesia, St. Francuska 20-24, 40-064 Katowice, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","unstructured":"Bex, A., Abu-Ghanem, Y.L., Bedke, J., Brent, D.L., Capitanio, U., Dabestani, S., Hora, M., Klatte, T., Kuusk, T., and Lund, L. (2024). EAU Guidelines on Renal Cell Carcinoma, European Association of Urology Guidelines Office."},{"key":"ref_2","first-page":"12","article-title":"Cancer statistics","volume":"74","author":"Siegel","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.eururo.2018.08.036","article-title":"Epidemiology of renal cell carcinoma","volume":"75","author":"Capitanio","year":"2019","journal-title":"Eur. Urol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1464-410X.2004.04897.x","article-title":"The Mayo Clinic experience with surgical management of RCC and venous tumor thrombus","volume":"94","author":"Blute","year":"2004","journal-title":"BJU Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.eururo.2022.03.006","article-title":"European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update","volume":"82","author":"Ljungberg","year":"2022","journal-title":"Eur. Urol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1016\/j.annonc.2024.05.537","article-title":"Renal cell carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up","volume":"35","author":"Powles","year":"2024","journal-title":"Ann. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1097\/JU.0000000000001911","article-title":"Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline: Part I","volume":"206","author":"Campbell","year":"2021","journal-title":"J. Urol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1097\/JU.0000000000001912","article-title":"Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-up: AUA Guideline: Part II","volume":"206","author":"Campbell","year":"2021","journal-title":"J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.eururo.2015.11.034","article-title":"Systematic Review of Surgical Management of Nonmetastatic Renal Cell Carcinoma with Vena Caval Thrombus","volume":"70","author":"Lardas","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1177\/1756287215576443","article-title":"Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma","volume":"7","author":"Psutka","year":"2015","journal-title":"Ther. Adv. Urol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.eururo.2009.11.008","article-title":"Cost Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate Cancer","volume":"57","author":"Bolenz","year":"2010","journal-title":"Eur. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1111\/j.1464-410X.1987.tb04832.x","article-title":"Surgical Treatment of Renal Cancer with Vena Cava Extension","volume":"59","author":"Neves","year":"1987","journal-title":"Br. J. Urol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/00000658-198909000-00014","article-title":"Vena caval involvement by renal cell carcinoma: Surgi-cal resection provides meaningful long-term survival","volume":"210","author":"Skinner","year":"1989","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/S0022-5347(17)42848-5","article-title":"Surgical Management of Renal Cell Carcinoma with Intracaval Neoplastic Extension Above the Hepatic Veins","volume":"139","author":"Marshall","year":"1988","journal-title":"J. Urol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1016\/S0003-4975(97)00329-9","article-title":"Surgical Management of Renal Cell Carcinoma With Inferior Vena Cava Tumor Thrombus","volume":"63","author":"Nesbitt","year":"1997","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/S0022-5347(05)64452-7","article-title":"Management of renal cell carcinoma with level III thrombus in the inferior vena cava","volume":"168","author":"Ciancio","year":"2002","journal-title":"J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/j.urology.2005.03.039","article-title":"Renal cell carcinoma with tumor thrombus extending above diaphragm: Avoiding cardiopulmonary bypass","volume":"66","author":"Ciancio","year":"2005","journal-title":"Urology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jvsv.2016.12.011","article-title":"Treatment options and outcomes for caval thrombectomy and resection for renal cell carcinoma","volume":"5","author":"Haidar","year":"2017","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.eururo.2010.08.038","article-title":"Initial Series of Robotic Radical Nephrectomy with Vena Caval Tumor Thrombectomy","volume":"59","author":"Abaza","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/j.juro.2015.09.094","article-title":"Multi-Institutional Experience with Robotic Nephrectomy with Inferior Vena Cava Tumor Thrombectomy","volume":"195","author":"Abaza","year":"2016","journal-title":"J. Urol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.juro.2015.03.119","article-title":"Robotic Level III Inferior Vena Cava Tumor Thrombectomy: Initial Series","volume":"194","author":"Gill","year":"2015","journal-title":"J. Urol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.eururo.2016.08.066","article-title":"Robot-assisted Level II\u2013III Inferior Vena Cava Tumor Thrombectomy: Step-by-Step Technique and 1-Year Outcomes","volume":"72","author":"Chopra","year":"2016","journal-title":"Eur. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.eururo.2019.04.019","article-title":"Robot-assisted Level III-IV Inferior Vena Cava Thrombectomy: Initial Series with Step-by-step Procedures and 1-yr Outcomes","volume":"78","author":"Wang","year":"2020","journal-title":"Eur. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.urology.2019.11.002","article-title":"Comparison of open and robot assisted radical nephrectomy with level I and II inferior vena cava tumor throm-bus: The Mayo Clinic experience","volume":"136","author":"Rose","year":"2020","journal-title":"Urology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e922987-1\u2013e922987-13","DOI":"10.12659\/MSM.922987","article-title":"Cumulative Sum Analysis of the Operator Learning Curve for Robot-Assisted Mayo Clinic Level I\u2013IV Inferior Vena Cava Thrombectomy Associated with Renal Carcinoma: A Study of 120 Cases at a Single Center","volume":"26","author":"Shen","year":"2020","journal-title":"Med. Sci. Monit."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/JU.0000000000002952","article-title":"Robotic level IV inferior vena cava thrombectomy using an intrapericardial control technique: Is it safe without cardiopulmonary bypass?","volume":"209","author":"Huang","year":"2023","journal-title":"J. Urol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/MOU.0000000000000690","article-title":"Complex robotic nephrectomy and inferior vena cava tumor thrombectomy: An evolving landscape","volume":"30","author":"Murphy","year":"2020","journal-title":"Curr. Opin. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1111\/1744-1633.70000","article-title":"Robotic surgical management of renal tumours with caval thrombosis: A comprehensive analysis and outcomes in a case series using minimally invasive approaches","volume":"29","author":"Durante","year":"2025","journal-title":"Surg. Pr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_31","unstructured":"Wells, G.A., Shea, B., O\u2019Connell, D., Peterson, J., Welch, V., and Losos, M. (2000). The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonrandomized Studies in Meta-Analyses, Ottawa Hospital Research Institute."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Baheen, Q., Liu, Z., Hao, Y., Sawh, R.R.R., Li, Y., Zhao, X., Hong, P., Wu, Z., and Ma, L. (2022). The significant role of tumor volume on surgical approach, complexity, and complications in RCC with venous tumor thrombus. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.869891"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"576.e17","DOI":"10.1016\/j.urolonc.2019.05.010","article-title":"Trends and outcomes in contemporary management of RCC with vena cava thrombus","volume":"37","author":"Beksac","year":"2019","journal-title":"Urol. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e2611","DOI":"10.1002\/rcs.2611","article-title":"Experiences of robot assisted thrombectomy with 2-year follow-up","volume":"20","author":"Cheng","year":"2023","journal-title":"Int. J. Med. Robot. Comput. Assist. Surg."},{"key":"ref_35","first-page":"8383","article-title":"Surgical and oncological outcomes of IVC thrombectomy by thrombus level","volume":"31","author":"Tappero","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4103\/ijc.IJC_5_20","article-title":"Survival analysis and predictors of long-term outcomes following radical nephrectomy with inferior vena cava (IVC) thrombectomy in renal cell carcinoma","volume":"60","author":"Garg","year":"2022","journal-title":"Indian J. Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.juro.2017.06.094","article-title":"Robotic versus open level I-II IVC throm-bectomy: Matched analysis","volume":"198","author":"Gu","year":"2017","journal-title":"J. Urol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Sandberg, M., Russell, G., Krol, P., Hayes, M., Bissette, R., Ben David, R., Patel, K., Aljabi, B., Byun, S.S., and Faba, O.R. (2025). Cy-toreductive nephrectomy with tumor thrombectomy: Open vs laparoscopic vs robotic. Cancers, 17.","DOI":"10.3390\/cancers17213490"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s11701-025-02424-z","article-title":"A compari-son of open, laparoscopic, and robotic radical nephrectomy with tumor thrombectomy from the intercontinental collabora-tion on renal cell carcinoma","volume":"19","author":"Sandberg","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"498","DOI":"10.23736\/S2724-6051.20.04052-7","article-title":"Robot-assisted versus open surgery for radical nephrectomy with IVC thrombus","volume":"73","author":"Vuong","year":"2021","journal-title":"Minerva Urol. Nephrol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., and Page, M.J. (2019). Cochrane Handbook for Systematic Reviews of Interventions, Wiley. [2nd ed.].","DOI":"10.1002\/9781119536604"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.eururo.2010.10.001","article-title":"Prognostic Impact of the 2009 UICC\/AJCC TNM Staging System for Renal Cell Carcinoma with Venous Extension","volume":"59","author":"Huang","year":"2011","journal-title":"Eur. Urol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1007\/s11934-014-0404-7","article-title":"Lessons learned from the International Renal Cell Carcinoma-Venous Thrombus Consortium (IRCC-VTC)","volume":"15","author":"Linares","year":"2014","journal-title":"Curr. Urol. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1016\/j.eururo.2013.10.029","article-title":"Perioperative Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Cava Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Experience","volume":"66","author":"Abel","year":"2014","journal-title":"Eur. Urol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/j.juro.2014.03.111","article-title":"Oncologic Outcomes Following Surgical Resection of Renal Cell Carcinoma with Inferior Vena Caval Thrombus Extending Above the Hepatic Veins: A Contemporary Multicenter Cohort","volume":"192","author":"Haddad","year":"2014","journal-title":"J. Urol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.juro.2014.07.087","article-title":"Impact of Synchronous Metastasis Distribution on Cancer Specific Survival in Renal Cell Carcinoma after Radical Nephrectomy with Tumor Thrombectomy","volume":"193","author":"Tilki","year":"2015","journal-title":"J. Urol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/14\/2251\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T10:23:34Z","timestamp":1784024614000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/18\/14\/2251"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":46,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["cancers18142251"],"URL":"https:\/\/doi.org\/10.3390\/cancers18142251","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}