Procedures

IVC Tumour Thrombectomy with Nephrectomy

The kidney is a paired organ in the upper abdomen that filters the blood of waste then excretes this filtered waste in the form of urine. The urine is transported from the kidney via the ureter to the bladder in the pelvis where it is stored.

When a high grade or large tumour develops within the kidney it may occasionally invade the inferior vena cava (IVC, a large blood vessel running in the middle of the abdomen) via the renal vein. In this situation nephrectomy (kidney removal) and IVC tumour thrombectomy (removal of the tumour within the IVC) is an option. This is a large operation and is reserved for young fit patients.

Pre operation

Ten days prior to the procedure you should:

  • Have your blood and urine test
  • Notify Mr Thyer’s rooms if you are taking any blood thinning medication
  • If you are taking clexane this should be ceased 24 hours prior to admission
The procedure

On arrival at hospital you will be prepared for theatre by nursing staff. Mr Thyer will see you just prior to being taken into the operating theatre. You will require a general anaesthetic of approximately 4 hours. Mr Thyer will make an incision across the abdomen. The abdominal contents will be shifted aside and the kidney and IVC dissected free. The IVC will be opened and the tumour within removed in one piece with the kidney. This specimen will be sent to a pathologist for microscopic examination (you may incur a pathologist fee). The IVC will be sutured closed and the abdominal contents will be replaced in their normal position. After the operation a drain will be left in the abdomen and a catheter in the bladder. Most patients spend one night in ICU then are shifted to the ward for a further 2-3 nights before being discharged home after Mr Thyer’s review.

Note:

  1. A vascular surgeon will be on standby to assist Mr Thyer if the tumour is invading the wall of the vena cava or excessive bleeding
  2. Liver and cardiothoracic surgeons may be required to mobilise the liver or open the chest to gain access to very proximal tumours.
Risks
  • Haemorrhage. There is minimal blood loss during most operations however the occasional operation does have bleeding complications. A vascular surgeon will always be available at the time of the operation to assist should major bleeding occur.
  • Infection. Wound infection is rare but may require a course of oral antibiotics to correct.
  • Injury to surrounding structures. The bowel, liver, spleen, adrenal, pancreas, kidneys and large blood vessels are close to the area of dissection and may require repair if injured during the dissection.
  • Bowel obstruction. There is a 1% lifetime risk of adhesions forming in the abdomen leading to bowel obstruction. This can usually be managed conservatively under the care of a general surgeon.
  • Hernia. Very occasionally (1%) a hernia can develop at the wound site which requires correction with a general surgeon.
  • Recurrence of cancer. Unfortunately we see cancer recur in 50-60% of patients with IVC tumour despite complete resection.
  • Pulmonary embolus. This is a relatively common complication following this surgery and all suitable patients are given blood thinning injections for 1 month.
  • There are risks with any general anaesthetic which are very rare including blood clots, heart or lung problems and adverse drug reactions. The anaesthetist will discuss these with you at the time of the procedure.
Follow up

Mr Thyer’s rooms will contact you to arrange follow up to check your progress, wounds and pathology 3 weeks following the operation. You should administer the blood thinning injections for 1 month. You should also take laxatives, wear compression stockings, drink plenty of water and avoid heavy lifting for 3 weeks following the procedure. You should not drive a motor vehicle until seen by Mr Thyer at the follow up appointment.

When to contact Mr Thyer

Following the procedure, you should contact Mr Thyer if you:

  • Have a fever over 38 Degrees
  • Feel your abdomen is becoming increasingly bloated
  • Have not received a follow up appointment
  • You can contact Mr Thyer via his rooms during working hours or after hours via the after hours nurse at Hollywood Hospital on (08) 9346 6000.

© 2019 Thyer Urology | Privacy Policy | Disclaimer | Website design: WebInjection