Purpose: To investigate perioperative clinicopathological predictors and establish a predictive nomogram for survival in patients with renal cell carcinoma (RCC) and venous tumor thrombus (VTT) undergoing nephrectomy and thrombectomy. Methods: Patients with RCC and VTT undergoing nephrectomy and thrombectomy were included in the study between January 2014 and June 2020. Cox regression analysis was used for univariate and multivariate survival analyses. A predictive nomogram for survival was established and internally validated using bootstrap resampling method. Results: A total of 223 patients were included in this study. The median age was 60 years (IQR, 53–66 years), consisting of 171(76.7%) males and 52(23.3%) females. The median follow-up time was 17.0 months (range, 1-74 months), 26.5% (59 of 223) patients died of all causes. In multivariable analysis, hemoglobin less than the low limit of normal (HR, 1.73; 95% CI, 1.01–2.95; P =0.045), sarcomatoid feature (HR, 3.67; 95% CI, 1.98–6.83; P<0.001), perirenal fat invasion (HR, 1.79; 95% CI, 1.04–3.08; P=0.034), histological subtype (HR, 2.74; 95% CI, 1.39–5.42; P=0.004), and metastasis at surgery (HR, 1.71; 95% CI, 1.01–2.91; P =0.047) were independent predictors of overall survival. The result of internal validation presented that the predictive performance of the nomogram for survival measured by C-index was 0.77. Conclusions: We developed a predictive nomogram with well internal validation for survival in patients with RCC and VTT, which can greatly promote risk stratification and treatment planning, as well as more accurate selection criteria for clinical trials of adjuvant therapies. External validation is still required to assess its universal applicability.