Successful Team-Based Management of Renal Cell Carcinoma With Caval Extension of Tumor Thrombus Above the Diaphragm

Spelde, Audrey E.; Steinberg, Toby; Patel, Prakash A.; Garcia, Harry; Kukafka, Jeremy D.; MacKay, Emily J.; Gutsche, Jacob T.; Frogel, Jonathan; Fabbro, Michael; Raiten, Jessie M.; Augoustides, John

doi:10.1053/j.jvca.2017.02.036

Cited by 8 publications

(12 citation statements)

References 90 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Central line placement with any level 4 tumor thrombus may benefit from TEE guidance due to the presence of thrombus in right atrium and the potential of inadvertent thrombus disruption . TEE imaging may also help guide PA catheter placement when used although PA catheters are not routinely utilized at our institution during these cases. Given this patient population's hypercoagulable state, TEE also allows for monitoring for other thromboembolic complications.…”

Section: Intraoperative Imaging With Teementioning

confidence: 99%

“…As described previously, even preoperative imaging obtained within days of surgery does not necessarily accurately reflect the current extent of the thrombus at surgery; therefore, TEE provides the most up‐to‐date thrombus level. Knowing the precise extent of the thrombus is essential for surgical planning and can impact everything from how to prep and drape to the incision that is used as well as the surgical approach to achieve vascular control . Depending on the tumor thrombus extent, a multidisciplinary team including vascular surgeons, cardiac surgeons, cardiac anesthesiologists, and perfusionists may be needed to allow for cardiopulmonary bypass (CPB) …”

Section: Intraoperative Imaging With Teementioning

confidence: 99%

“…Intraoperative pulmonary embolus (PE) is associated with 75% mortality; therefore, prompt diagnosis and treatment are of the utmost importance . Many studies indicate that using TEE intraoperatively allows for the quick identification of intraoperative emboli . In one study, two out of five patients who developed intraoperative emboli seen by TEE did not exhibit any hemodynamic instability and may have otherwise not been identified and properly treated .…”

Section: Intraoperative Imaging With Teementioning

confidence: 99%

“…Knowing the precise extent of the thrombus is essential for surgical planning and can impact everything from how to prep and drape to the incision that is used as well as the surgical approach to achieve vascular control. 22,41,42 Depending on the tumor thrombus extent, a multidisciplinary team including vascular surgeons, cardiac surgeons, cardiac anesthesiologists, and perfusionists may be needed to allow for cardiopulmonary bypass (CPB). 41 There are examples of the use of intraoperative TEE allowing for potentially less morbid procedures.…”

Section: Intraoperative Embolic Phenomenon May Cause Only Subtle Chanmentioning

confidence: 99%

“…22,41,42 Depending on the tumor thrombus extent, a multidisciplinary team including vascular surgeons, cardiac surgeons, cardiac anesthesiologists, and perfusionists may be needed to allow for cardiopulmonary bypass (CPB). 41 There are examples of the use of intraoperative TEE allowing for potentially less morbid procedures. For example, one study described a technique which allowed for the avoidance of liver mobilization by utilizing a Fogarty catheter for thrombus extraction under TEE guidance.…”

Section: Intraoperative Embolic Phenomenon May Cause Only Subtle Chanmentioning

confidence: 99%

See 4 more Smart Citations

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

et al. 2018

View full text Add to dashboard Cite

We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control.

show abstract

Section: Intraoperative Imaging With Teementioning

confidence: 99%

Section: Intraoperative Imaging With Teementioning

confidence: 99%

Section: Intraoperative Imaging With Teementioning

confidence: 99%

Section: Intraoperative Embolic Phenomenon May Cause Only Subtle Chanmentioning

confidence: 99%

Section: Intraoperative Embolic Phenomenon May Cause Only Subtle Chanmentioning

confidence: 99%

See 3 more Smart Citations

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

et al. 2018

View full text Add to dashboard Cite

show abstract

Is Pulmonary Artery Catheter Placement in the Setting of Right Atrial Tumor Thrombus Worth the Risk?

Essandoh

2018

Journal of Cardiothoracic and Vascular Anesthesia

View full text Add to dashboard Cite

inadvertently may have unmasked the patient allocation to both anesthetic and nursing staff. We wonder if the use of a blinding questionnaire would have detected this. We also question who is best placed to insert the paravertebral catheter. Although the technique may be associated with fewer side effects than the gold standard thoracic epidural and the remaining risks can be minimized by the use of ultrasound guidance, pleural placement still can take place, as reported in 12% of patients in this study. In our unit, we have now moved to surgical placement under direct vision, which may be both more effective and time efficient. 5 References 1 Dutta V, Kumar B, Jayant A, et al. Effect of continuous paravertebral dexmedetomidine administration on intraoperative anesthetic drug requirement and post-thoracotomy pain syndrome after thoracotomy: A randomized controlled trial.

show abstract

Role of the Pulmonary Artery Catheter in Integrated Management of Renal Cell Carcinoma With Significant Caval Extension of Tumor Thrombus

Spelde

Steinberg

Patel

et al. 2018

Journal of Cardiothoracic and Vascular Anesthesia

Self Cite

View full text Add to dashboard Cite

Successful Team-Based Management of Renal Cell Carcinoma With Caval Extension of Tumor Thrombus Above the Diaphragm

Cited by 8 publications

References 90 publications

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus

Is Pulmonary Artery Catheter Placement in the Setting of Right Atrial Tumor Thrombus Worth the Risk?

Role of the Pulmonary Artery Catheter in Integrated Management of Renal Cell Carcinoma With Significant Caval Extension of Tumor Thrombus

Contact Info

Product

Resources

About