Introduction
Kidney cancer constitutes about 3% of all malignancies in the adult population.1 It is the 7th most common cancer in men and the 10th most common cancer in women.2 More than 400,000 new cases of Renal cell carcinoma (RCC) were reported globally in 2018.3 Each year, roughly 63,000 new RCC cases are diagnosed with 14,000 deaths in the United States (U.S.).4 It is twice as common in men as compared to women.5 The classic triad of palpable flank pain, flank mass, and hematuria for RCC are usually seen in advanced cases.6 RCC is associated with coagulopathy and development of inferior vena cava (IVC) thrombus in 4–10% of cases, with approximately only 1% extending into the right atrium.1 Metastasis is common to the lungs, liver, lymph nodes, brain, bones and a significant predictor of prognosis in RCC.7 With the increasing use of imaging, more than 70 % of all RCC being diagnosed as an incidental finding on imaging studies.7 The most common histological type of RCC is clear cell cancer (70-80%), followed by papillary renal cell cancer (10-20%).7 It is more common in patients with hypertension, hyperlipidemia, smoking, end-stage renal disease, acquired cystic renal disease, kidney transplantation, and tuberous sclerosis syndrome.8 More than 30 % of patients with RCC found to have metastatic disease at the time of diagnosis.9The five-year survival with localized RCC is 92.1%, with the regional disease is 65.4%, and with metastatic RCC is only 11.8%.10 A combination of cytoreductive nephrectomy with systemic targeted therapies is currently being used for metastatic RCC due to tumors’ highly immunogenic nature.11Radical surgical resection remains the definitive curative and palliative treatment in patients with IVC thrombus propagating to the right atrium without significant systemic metastases.12 However, IVC thrombectomy is associated with significant morbidity and mortality and requires careful patient selection with a multidisciplinary care team approach for better outcomes.12