(UroToday.com) At the European Association of Urology (EAU) Section of Oncological Urology (ESOU) 2021 virtual meeting, Dr. Arnaud Mejean discussed surgical and perioperative challenges of large renal tumors, particularly those with vena cava and lymph node involvement. Dr. Mejean notes that statistics from the SEER database suggest that 19% of patients present with locoregional disease, making this an important area of management. Historical data from an international multicenter study shows that based on UCLA Integrated Staging System (UISS) stratification for localized renal cell carcinoma (RCC), the 5-year survival rates were 92%, 67%, and 44% for low-, intermediate-, and high-risk groups, respectively.1 For metastatic RCC, the 3-year survival rates were 37%, 23%, and 12% for low-, intermediate-, and high-risk groups, respectively: