Objective
To determine the impact of transesophageal echocardiography on the surgical management
of patients undergoing nephrectomy and inferior vena cava tumor thrombectomy for renal
cell carcinoma.
Materials and Methods
We retrospectively analyzed intraoperative records of 67 patients with renal cell
carcinoma and level II-IV invasion of the inferior vena cava who underwent nephrectomy
with tumor thrombectomy between 2007 and 2015. Based on preoperative imaging, patients
were categorized according to vena cava thrombus level. Diagnostic utility and impact
on surgical management were extracted from the operative note, anesthesia record,
and intraoperative echocardiography report.
Results
Twelve of 34 patients (35%) with level II thrombus, 14 of 18 (78%) with level III
thrombus, and 15 of 15 (100%) with level IV thrombus had intraoperative transesophageal
echocardiography. With increasing level of tumor thrombus, the diagnostic yield and
surgical impact increased. Echocardiography provided new diagnostic information in
7 of 12 (58%) patients with level II thrombus and altered surgical management in 16%.
Among level III thrombus patients, echocardiography provided new diagnostic information
in 12 of 14 (86%) and altered surgical management in 21%. Echocardiography provided
new diagnostic information and impacted surgical management in all 15 (100%) patients
with a level IV thrombus.
Conclusion
The diagnostic yield of intraoperative transesophageal echocardiography increases
in patients with greater vena caval tumor thrombus extension. This information has
a significant influence on surgical decision-making.
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Article info
Publication history
Published online: March 30, 2017
Accepted:
March 2,
2017
Received:
December 12,
2016
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
