Objective To explore the efficacy and safety of the "cross three-step" strategy in the treatment of inferior vena cava leiomyosarcoma (IVCL) across the orifice of renal vein.

Methods From October 2020 to August 2022, 9 patients diagnosed as IVCL across the orifice of renal vein who received "cross three-step" operation strategy in Changhai Hospital were selected. The general data, imaging findings, operation records, and postoperative complications were collected. The preoperative and postoperative renal function indexes were compared, and the patients were followed up by outpatient clinic or telephone.

Results All the 9 patients completed surgery and discharged from hospital, including 4 unilateral nephrectomy, 4 renal vein prosthesis recontruction and 1 inferior vena cava prosthesis reconstruction. The average operative blood loss was (1966.7±1296.1) mL and the average operation time was (179.4±42.9) min. There was no significant difference in serum creatinine between preoperative and postoperative 2 weeks in all patients, and patients underwent unilateral nephrectomy or renal vein reconstruction.

Conclusion The "cross three-step" surgical strategy standardizes the complicated and variable surgical procedures of inferior vena cava tumors, which is replicable and helpful to shorten the learning curve of the operators. The operation is safe and reliable, and the postoperative renal functions of these patients are well recovered.