In a study of 256 patients treated surgically for renal cell carcinoma (RCC) with venous thrombus at the University of Texas MD Anderson Cancer Center between 1993 and 2009, median recurrence-free interval was significantly shorter in patients with positive vascular margins (22.1 months vs 70.2 months). However, although tumour invasion into the vein wall at the resection margin was independently predictive of local recurrence, multivariable analysis revealed that it had minimal effect on systemic recurrence or cancer-specific survival.