Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma

Oikawa, Takehiro; Shimazui, Toru; Johraku, Akira; Kihara, Shinichi; Tsukamoto, Shigeki; Miyanaga, Naoto; Hattori, Kazunori; Kawai, Koji; Uchida, Keiji; Takeshima, Hitoshi; Sasaki, Shigeyuki; Toyooka, Hidenori; Akaza, Hideyuki

doi:10.1111/j.1442-2042.2003.00780.x

Cited by 40 publications

(33 citation statements)

References 13 publications

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“…[14][15][16] Investigators have found TEE to be accurate in monitoring intraoperative embolic phenomena during tumor manipulation, 17 evaluating IVC tumor extension, 18 recognizing residual tumor after attempted resection, 19 and evaluating preload and cardiac function during IVC clamping. Oikawa and colleagues 20 described the additional use of intraoperative TEE to position an intracaval balloon above the tumor thrombus, thus enabling resection without the need to mobilize the liver.…”

Section: Discussionmentioning

confidence: 99%

Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

Ahmed¹,

Al-Najjar²,

Aftab³

et al. 2015

Texas Heart Institute Journal

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P ulmonary tumor embolization from renal cell carcinoma (RCC) is associated with severe cardiopulmonary morbidity and high perioperative mortality rates. In one study, 1 the direct extension of RCC into the inferior vena cava (IVC) was observed in 22 of 295 patients (7%). Massive pulmonary embolism (PE) can occur during surgical treatment for RCC, especially when the tumor extends into the IVC.2-6 Advantages of using transesophageal echocardiography (TEE) during RCC excision include evaluating the cephalic extension of tumor into the IVC, monitoring the tumor during surgical mobilization, and evaluating cardiac function. 7,8We report a case in which continuous TEE monitoring prevented a patient's death from PE, when RCC extended into the IVC. Case ReportIn January 2012, a 71-year-old woman presented with severe right-sided abdominal pain. The patient's medical history included hypertension, chronic obstructive pulmonary disease, osteoarthritis, peptic ulcer disease, glaucoma, aortic insufficiency, mitral regurgitation, and hyperlipidemia. Her surgical history was notable for a C-section and treatment of a perforated peptic ulcer. Her medications included amlodipine, digoxin, hydrochlorothiazide, lisinopril, omeprazole, pravastatin, spironolactone, and zolpidem. She had no known drug allergies. Until recently, she had smoked one pack of cigarettes per day for approximately 15 years. Magnetic resonance images of the patient's abdomen revealed a 9.5 × 6-cm mass in the right kidney with a 2-to 3-cm extension into the infrahepatic portion of the IVC (Figs. 1 and 2). Contrast computed tomograms (CT) of the chest revealed substantial mediastinal lymphadenopathy and multiple small lung nodules. Results of a bone scan were negative. We decided to perform radical nephrectomy and resection of the intracaval mass. The urology team informed the patient that, at worst, surgery would be palliative rather than curative and might extend her life only for months.The patient's preoperative blood pressure (BP) was 120/65 mmHg, and her heart rate was 80 beats/min. She was given 2 mg of midazolam, and general anesthesia was induced. The patient was monitored by means of electrocardiography (ECG), pulse oximetry, a radial arterial line, a central venous pressure line, end-tidal carbon dioxide measurement, and a rectal temperature probe. An iE33 xMATRIX Echocardiography System probe (Koninklijke Philips N.V.; Best, The Netherlands) was placed. Initially,

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Section: Discussionmentioning

confidence: 99%

Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

Ahmed¹,

Al-Najjar²,

Aftab³

et al. 2015

Texas Heart Institute Journal

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“…In the literature, it has also been used for dilation of ureteropelvic obstruction, 6 avulsion of posterior urethral valves, 7 retrieval of indwelling ureteral stents 8,9 or intraoperative thrombectomy of inferior vena caval tumor of renal cell carcinoma 10 in urological diseases. The Fogarty catheter can be easily passed from an incision of the pelvis into the upper ureter distal to the expected narrow site.…”

Section: Discussionmentioning

confidence: 99%

Identification of the narrow lumen of the ureter using a Fogarty catheter during laparoscopic pyeloplasty

et al. 2012

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It is difficult to identify the narrow sites of the ureter from the outside while carrying out laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. We developed and named a new method, the Fogarty test, to identify the narrow sites of the ureter using a Fogarty catheter. A 4-to 5-Fr Fogarty catheter was inserted through an incision in the pelvis to the proximal ureter, inflated with air and withdrawn gently to determine resistance. The narrow lumen of the ureter was identified under direct vision and spatulated by laparoscopic scissors. This procedure was carried out repeatedly until the ureter was fully spatulated. By using the Fogarty test, we can visualize the narrow position and length of the ureter under direct vision, and confirm whether it is fully spatulated or not. This technique is very simple and easy to carry out. We believe it is useful for sufficient spatulation of intrinsic ureteral stricture, especially in patients where multiple narrow sites exist.

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“…of tumor thrombi in the IVC or right atrium, intraoperative TEE can reveal tumor adherence to the IVC, mobility, and fragility-factors that greatly increase the risk of pulmonary embolism. 10 In our case, TEE enabled us to detect the cephalad extent of the thrombus and to quickly recognize the tumor's movement into the patient's tricuspid valve and embolization of the tumor thrombus into the main pulmonary artery.…”

Section: Discussionmentioning

confidence: 99%

Selective Upper-Body Perfusion Technique for Removal of Renal Cell Carcinoma Extending into the Inferior Vena Cava and Right Atrium

Aydın¹,

Cengiz²,

Gökay³

et al. 2017

Texas Heart Institute Journal

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Invasion of a renal cell carcinoma thrombus into the inferior vena cava and right atrium is infrequent. Reaching and completely excising a tumor from the inferior vena cava isR enal cell carcinoma (RCC) is the most prevalent malignant kidney tumor. Although extension of the tumor thrombus into the inferior vena cava (IVC) has been reported in 5% to 10% of cases, 1 extension up to the right-sided heart chambers is seen in only 1% of patients with RCC.2 The mainstay of treatment in these patients is radical nephrectomy with complete surgical removal of the tumor thrombus, including the portions extending into the IVC and right atrium. The usual surgical approach is to combine intra-abdominal and cardiac surgery with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA); this provides a bloodless surgical field, eliminates the need for IVC cannulation, and facilitates complete removal of the cavoatrial mass.3 However, DHCA has well-known deleterious systemic effects and increases the risk of neurologic complications. 4 To avoid DHCA, we used a selective upper-body perfusion technique during the operation to remove a tumor thrombus extending into the IVC and right atrium in a patient with RCC. We also used a piggyback liver dissection technique to facilitate en bloc tumor resection and patch closure. Case ReportIn February 2016, a 61-year-old man was referred to our hospital with a diagnosis of RCC in the right kidney and tumor thrombus extending into the IVC and right atrium. The patient, who presented with right flank pain, hematuria, and dysuria, had a history of hypertension, type 2 diabetes mellitus, and hypothyroidism. No abnormalities were found on physical examination, except for a palpable abdominal mass in the right upper quadrant. Routine hematologic and biochemical laboratory tests were conducted, and the results were normal. Computed tomograms revealed a 122 × 98 × 106-mm mass in the right kidney that extended into the IVC and right atrium (Fig. 1). Positron emission tomograms showed no distant metastases. A transthoracic echocardiogram showed a 35 × 27-mm mass in the IVC and right atrium ( Fig. 2A). Cardiac and valvular function were normal. Coronary angiography was performed, and no coronary artery disease was detected. Combined abdominal and cardiac surgery was planned for complete removal of the RCC and tumor thrombus.

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Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma

Cited by 40 publications

References 13 publications

Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

Early Detection of a Cavopulmonary Tumor Embolus with the Use of Transesophageal Echocardiography

Identification of the narrow lumen of the ureter using a Fogarty catheter during laparoscopic pyeloplasty

Selective Upper-Body Perfusion Technique for Removal of Renal Cell Carcinoma Extending into the Inferior Vena Cava and Right Atrium

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