Abstract: Objective To preliminarily explore perioperative safety management strategies for patients with renal cell carcinoma (RCC) complicated by heart failure (HF). Methods The clinical data from patients with RCC complicated by HF who underwent surgery at Beijing Anzhen Hospital, Capital Medical University, from March 2023 to March 2025 were retrospectively analyzed. The clinical data included baseline characteristics, cardiac functional parameters, operative variables, perioperative management strategies, in⁃hospital complications, and postoperative outcomes, which were obtained through telephone follow⁃up. For statistical analysis, the Wilcoxon rank⁃sum test and Kruskal⁃Wallis test were used to compare non⁃normally distributed data across different groups, while the Wilcoxon signed⁃rank test was used to assess changes in B⁃type natriuretic peptide (BNP) levels pre⁃ and postoperative. Multivariable linear regression was performed to analyze correlations among continuous variables to identify baseline or perioperative factors influencing safety outcomes. Results Twenty patients were enrolled, comprising 18 males and 2 females. According to New York Heart Association(NYHA) classification, gradeⅡ in 2, grade Ⅲ in 15, and gradeⅣin 3 patients. The left ventricular ejection fraction (LVEF) was ≤30% in 5, 30%<LVEF≤40% in 8, 40%<LVEF≤49% in 4, and LVEF≥50% in 3 patients. Radical nephrectomy was performed in 18 patients, while partial nephrectomy in 2 patients. The median operative time was 100.00 (88.75, 110.00) mins, and the median intraoperative blood loss was 20.00 (10.00, 50.00) mL. Postoperative day⁃1 BNP levels were significantly higher than preoperative levels [274.00 (204.25-393.50) pg/mL vs 94.00 (50.00-229.50) pg/mL，　P=0.004]. Two perioperative complications occurred within 30 d, including one acute myocardial infarction and one stress⁃related gastric ulcer, and no episodes of acute decompensated HF were observed. The median follow⁃up duration was 18.5 (4.0-28.0) months. Nineteen patients survived, while one patient died due to distant tumor metastasis. NYHA functional class improved by 2 levels in 6 patients, by 1 level in 10 patients, remained unchanged in 2 patients, and worsened by 1 level in 1 patient, demonstrating a significant improvement in postoperative cardiac function compared with preoperative status. Conclusions Nephrectomy is safe and feasible for RCC patients with NYHA class Ⅱ-Ⅳ　HF (LVEF 25%-60%) when preceded by comprehensive preoperative evaluation and medical adjustment, optimized intraoperative anesthetic management, and vigilant postoperative monitoring and pain control. No perioperative episodes of acute decompensated HF occurred, and postoperative cardiac function improved, suggesting that surgical treatment can be safely performed in RCC patients with HF under structured perioperative management strategies.

Key words: Renal cell carcinoma, Heart failure, Left ventricular ejection fraction, Perioperative management