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PurposePulmonary embolism with viable tumor cells developed after surgery for renal cell carcinoma may metastasize to lung. We investigated the incidence and fate of newly developed pulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus.MethodsAmong 4549 renal cell carcinoma patients treated with curative surgery at our institute from 1998 to 2015, 81 non-metastatic renal cell carcinoma patients with vena cava thrombus were included. The clinical course of pulmonary embolism and its impact on oncological outcomes were assessed.ResultsPostoperatively, pulmonary embolism developed in 13 patients (16.0%), who had higher level of vena cava thrombus (p = 0.004), more frequent liver mobilization (p = 0.005), and higher amount of intraoperative transfusion (p = 0.024) than patients without pulmonary embolism. The rate of lung metastasis was similar between patients with and without pulmonary embolism (30.8 vs. 35.3%, p = 1.000). In the multivariate analysis, the significant risk factors for disease recurrence were non-clear cell histology (p = 0.014) and larger primary renal tumor size (p = 0.032). Non-clear cell histology (p = 0.003) was the only significant risk factor for cancer-specific survival. Pulmonary embolism was not associated with both recurrence-free and cancer-specific survival.ConclusionsPulmonary embolism after surgery for renal cell carcinoma with vena cava thrombus was not associated with worse oncological outcomes and can be closely followed up with anticoagulation therapy.