BACKGROUND: Inferior vena cava (IVC) resection and reconstruction is a viable option for managing complex intra-abdominal tumours. This study evaluates the impact of surgical approach to IVC reconstruction on early oncological, post-operative and short-term survival outcomes. METHODS: This retrospective cohort study included patients who underwent IVC reconstruction between January 2015 and June 2024 for any indication, at two tertiary referral hospitals in Sydney, Australia. Data extracted included demographics, anticoagulation, histopathological findings, post-operative complications and short-term survival. Outcomes were compared among patients who received an interposition graft, patch graft or primary repair (non-graft) using nonparametric statistical tests. RESULTS: Seventy-one IVC reconstructions were performed with median age 59 years (IQR 48-69). A bovine pericardium (BP) graft was used in 86% of procedures (n=61). The most common indications for surgery were soft tissue sarcoma (n=17) and renal cell carcinoma (n=16). Post-operatively, there were seven cases of pulmonary embolism (PE), nine cases of graft thrombosis and one case of graft infection. 30-day survival was 99% and 12-month survival was 78%. Tumour size was greater in the interposition graft group (p=0.004), however no differences in post-operative complications or survival were observed between interposition graft, patch graft or primary repairs. CONCLUSIONS: IVC reconstruction, particularly using BP, is feasible across a range of tumour types and offers favourable post-operative and short-term survival outcomes, independent of reconstruction technique. BP interposition graft facilitates resection of more extensive disease with similar outcomes to less extensive disease managed with primary repair or patch graft.