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Table 2 Surgical steps as per level of IVC involvement by tumor.

From: Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

Surgical steps - IVC involvement
Level I-II (60% of the cases) No cardiothoracic involvement/Cardiothoracic "back up" only
Level III & IV disease mandates Cardiothoracic involvement
↓      ↓
LEVEL III (12-15% of the cases)
LEVEL IV (25% of the cases)
CPB, Pringle manoeuvre and if necessary
Always use of CPB and brief period of cross clamp of sub-diaphragmatic aorta TCA
If suboptimal thrombectomy, then brief TCA