Perioperative Management of the Genitourinary Oncologic Patient Undergoing Partial/Radical Nephrectomy

  • Clarissa StapletonEmail author
  • Christina Duffy
  • Jonathan Duplisea
Reference work entry


Renal cell carcinoma has one of the highest mortality rates of genitourinary cancers (Cairns, Cancer Biomark 9:461–473, 2012). The incidence of this disease has risen steadily. However, survival rates have improved substantially due to an increase in incidental detection and active surveillance with early treatment and management. Despite the control of cancer progression and better survival, patients are still being diagnosed with advanced disease and metastases. A collaborative management strategy consisting of surgery and targeted therapy is needed to improve patient outcomes (Cairns, Cancer Biomark 9:461–473, 2012).


Renal cell carcinoma Radical nephrectomy Partial nephrectomy Enhanced recovery after surgery (ERAS) Anesthesia technique Management Complications 


  1. 1.
    American Cancer Society (ACS). Kidney cancer stages. 2017. Retrieved from
  2. 2.
    American Cancer Society. Key statistics about kidney cancer. 2019. Retrieved from
  3. 3.
    Chapman D, Moore R, Klarenbach S, Braam B. Residual renal function after partial or radical nephrectomy for renal cell carcinoma. Can Urol Assoc J = J Assoc Urol Can. 2010;4(5):337–43.CrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. Kidney cancer. 2018. Retrieved from
  5. 5.
    Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods, and major patterns in globcan 2012. Int J Cancer. 2015;136(5):E359–86. Retrieved from
  6. 6.
    Hass NB, Nathanson KL. Hereditary renal cancer syndromes. Adv Chronic Kidney Dis. 2015;21(1). Retrieved from
  7. 7.
    Kabaria R, Klaassen Z, Terris MK. Renal cell carcinoma: links and risks. Int J Nephrol Renov Dis. 2016;9:45–52. Retrieved from
  8. 8.
    Kang SK, Chandarana H. Contemporary imaging of the renal mass. Urol Clin N Am. 2012;39(2):161–70.CrossRefGoogle Scholar
  9. 9.
    Khandekar MJ, Cohen P, Spiegelman BM. Molecular mechanisms of cancer development in obesity. Nat Rev Cancer. 2011;11:886–95. Retrieved from
  10. 10.
    Liao LM, Schwartz K, Pollack M, et al. Serum leptin and adiponectin levels and risk for renal cell carcinoma. Obesity. 2013;21(7):1478–85. Retrieved from
  11. 11.
    Mandani A, Patidar N, Pallavi A, Pande S, Tewari P. A new classification of inferior vena cava thrombus in renal cell carcinoma could define the need for cardiopulmonary or venovenous bypass. Indian J Urol. 2015;31(4):327–32.CrossRefGoogle Scholar
  12. 12.
    Nabi S, Kessler ER, Bernard D, et al. Renal cell carcinoma: a review of biology and pathophysiology. F1000 Res. 2018. Retrieved from
  13. 13.
    National Cancer Institute. Cancer stat facts: kidney and renal pelvis cancer. 2018. Retrieved from
  14. 14.
    Palsodttir H, Hardarson S, Petursdottir V, Jonsson A, Jonsson E, Sigurdsson I, Einarsson E, Gudbjartsson T. Incidental detection of renal cell carcinoma as in independent prognostic marker. J Urol. 2012;187(1):48–53.CrossRefGoogle Scholar
  15. 15.
    Parker A, Lohse C, Leibovich B, Igel T, Blute M. Evaluation of the association of current cigarette smoking and outcome for patients with clear cell renal cell carcinoma. Int J Urol. 2008;15(4):304–8.CrossRefGoogle Scholar
  16. 16.
    Reuter S, Gupta SC, Chaturvedi MM, et al. Oxidative stress, inflammation, and cancer: how are they linked? Free Radic Biol Med. 2010;49(11):1603–16. Retrieved from
  17. 17.
    Rink M, Xylinas E, Margulis V, et al. Impact of smoking on oncologic outcomes of upper tract urothelial carcinoma after radical nephroureterectomy. Eur Urol. 2013;63(6):1082–90. Retrieved from
  18. 18.
    Sanfilippo KM, McTigue KM, Fidler CJ, et al. Hypertension and obesity and the risk of kidney cancer in two large cohorts of US men and women. Hypertension. 2014;63(5):934–41. Retrieved from
  19. 19.
    The National Comprehensive Cancer Network for patients with kidney cancer. 2017. Retrieved from
  20. 20.
    Tsivian M, Moreira DM, Caso JR, et al. Cigarette smoking is associated with advanced renal cell carcinoma. J Clin Oncol. 2011. Retrieved from
  21. 21.
    US Department of Health and Human Services. The health consequences of smoking- 50 years of progress. 2014. Retrieved from
  22. 22.
    Zhang ZL, Li HY, Zhou JF. Complications of radical nephrectomy for renal cell carcinoma. 2015. Retrieved from
  23. 23.
    Cairns P. Renal cell carcinoma. Cancer Biomark. 2012;9(1–6):461–73.Google Scholar
  24. 24.
    Zhang Z-L, Li Y-H, Luo J-H, Liu Z-W, Yao K, Dong P, Han H, Qin Z-K, Chen W, Zhou F-J. Complications of radical nephrectomy for renal cell carcinoma: a retrospective study comparing transperitoneal and retroperitoneal approaches using a standardized reporting methodology in two Chinese centers. Chin J Cancer. 2013;32(8):461–8.CrossRefGoogle Scholar
  25. 25.
    AlBalawi Z, Gramlich L, Nelson G, Senior P, Youngson E, McAlister FA. The impact of the implementation of the enhanced recovery after surgery (ERAS®) program in an entire health system: a natural experiment in Alberta, Canada. World J Surg. 2018;42(9):2691–700.CrossRefGoogle Scholar
  26. 26.
    Martin TD, Lorenz T, Ferraro J, Chagin K, Lampman RM, Emery KL, Zurkan JE, Boyd JL, Montgomery K, Lang RE, Vandewarker JF, Cleary RK. Newly implemented enhanced recovery pathway positively impacts hospital length of stay. Surg Endosc. 2016;30(9):4019–28.CrossRefGoogle Scholar
  27. 27.
    Martin LW, Sarosiek BM, Harrison MA, Hedrick T, Isbell JM, Krupnick AS, Lau CL, Mehaffey JH, Thiele RH, Walters DM, Blank RS. Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg. 2018;105(6):1597–604.CrossRefGoogle Scholar
  28. 28.
    Smith HJ, Boitano TKL, Rushton T, Johnston MC, Leath CA, Straughn JM. Impact of enhanced recovery after surgery (ERAS) protocol on postoperative pain control in chronic narcotic users. Gynecol Oncol. 2018;149:19.CrossRefGoogle Scholar
  29. 29.
    Thiele RH, Raghunathan K, Brudney CS, Lobo DN, Martin D, Senagore A, Cannesson M, Gan TJ, Mythen MMG, Shaw AD, Miller TE, For the Perioperative Quality Initiative (POQI) I Workgroup. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med. 2016;5(1):1–15.CrossRefGoogle Scholar
  30. 30.
    Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, Umapathi BA, Kron IL, Sawyer RG, Hedrick TL, McMurry TL. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430–43.CrossRefGoogle Scholar
  31. 31.
    American Society of Anesthesiologists. Maintaining blood pressure levels measured before entering O.R. may improve outcomes. 2015. Retrieved from
  32. 32.
    Chapman E, Pichel A. Anesthesia for nephrectomy. BJA Educ. 2015;16(3):98–101.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Clarissa Stapleton
    • 1
    Email author
  • Christina Duffy
    • 1
  • Jonathan Duplisea
    • 2
  1. 1.Department of Anesthesiology, Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Urology, Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations