Radical Nephrectomy with Inferior Vena Cava (IVC) Thrombectomy: Implications for Post-operative Nursing Care

Implications for Post-operative Nursing Care

Janee Klipfel, BSN, RN, CURN; Therese M. Jacobson, MSN, APRN-BC, CWOCN; Michelle Havel, BSN, RN, CURN

Disclosures

Urol Nurs. 2010;30(6):347-352. 

In This Article

Abstract and Introduction

Abstract

The surgery required to remove a renal cell carcinoma with inferior vena cava (IVC) tumor thrombus is complex. IVC tumor thrombus is a complicating factor that occurs in 4% to 10% of patients with renal cell carcinoma. Nurses need to understand this surgical procedure and its inherent risks to proactively and successfully manage the patient's post-operative care and discharge plan.

Introduction

According to National Cancer Institute (NCI) (2010a) estimates, 58,240 U.S. men and women will be newly diagnosed with and 13,040 individuals will die from kidney and renal pelvis cancers in 2010. Renal cell carcinoma is adenocarcinoma that chiefly originates in the proximal tubule, and it accounts for approximately 85% of all primary malignant renal tumors. Most other renal cancers are urothelial cell cancers of the renal pelvis (NCI, 2010b).

The incidence of renal cell carcinoma has been rising over the past few decades (Hock, Lynch, & Balaji, 2002). This can be partially explained by the increasing use of abdominal imaging, such as CT and MRI scans. While the majority of these incidentally identified cancers represent localized disease, the incidence of advanced and metastatic disease is also increasing (DeCastro & McKiernan, 2008).

The probability of surviving renal cell carcinoma is directly related to the stage or degree of tumor spread beyond the kidney, with a survival rate of at least five years for approximately 40% of all renal cell carcinoma patients (NCI, 2010b). The American Joint Committee on Cancer Tumor Nodes Metastases (TNM) staging system is used to determine a treatment plan and prognosis based on tumor spread (Tanagho & McAninch, 2008).

The kidneys are highly vascular, and renal cell carcinoma has a tendency to produce clots or thrombi that often extend beyond the kidney. This may occur in 4% to 10% of patients with renal cell carcinoma (Schefft, Novick, Straffon, & Stewart, 1978). Tumor thrombi can extend from the kidney into the renal vein, which is the short, thick vein leaving the kidney, and then into the inferior vena cava (IVC), which is the large vein bringing blood from the lower extremities, pelvis, and abdomen to the right atrium of the heart (see Figure 1). In some instances, the malignant tumor thrombus adheres to the IVC wall. In the absence of tumor spread beyond the kidney, blood vessel involvement even into the vena cava does not necessarily indicate poor prognosis (NCI, 2010b).

Figure 1.

Source: Copyrighted and used with permission from Mayo Foundation for Medical Education and Research, all rights reserved.

In patients with renal cell carcinoma and IVC involvement, radical nephrectomy with IVC thrombectomy is the only possibly curative option (Novick, 2006). The operative procedure to remove a renal cell carcinoma with IVC tumor thrombus is complex. The focus of this article is on the post-operative nursing management of the patient with renal cell carcinoma undergoing radical nephrectomy with IVC thrombectomy. An overview of the surgical procedure will be discussed to provide a better understanding of the implications for post-operative nursing care.

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