Invasive renal cell carcinoma with inferior vena cava tumor thrombus: Cardiac anesthesia in liver transplant settings

Kyota Fukazawa, Edward Gologorsky, Kirstin Naguit, Ernesto Pretto, Tomas Salerno, Mohan Arianayagam, Richard Silverman, Michael Barron, Gaetano Ciancio

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives Resection of renal cell carcinomas (RCC) with tumor thrombus invasion into the inferior vena cava (IVC) is associated with significant perioperative morbidity and mortality. This study examined the intra- and inter-departmental collaboration among cardiac, liver transplantation, and urologic surgeons and anesthesiologists in caring for these patients. Design After IRB approval, medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010 in this institution, were reviewed. Data were collected and analyzed by one way-ANOVA and chi-square test. Setting Major academic institution, tertiary referral center. Participants This was a retrospective study based on the medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010. Interventions None. Measurements and Main Results Fifty-eight patients (82.9%) with level III thrombus and 12 patients (17.1%) with level IV thrombus were analyzed. Sixty-five (92.9%) did not require any extracorporeal circulatory support; 5 (2 with level III and 3 with level IV; 7.1%) required cardiopulmonary bypass. No patients required veno-venous bypass. Compared to patients with level III thrombus extension, patients with level IV had higher estimated blood loss (6978±2968 mL v 1540±206, p<0.001) and hospital stays (18.8±1.6 days v 8.1±0.7, p<0.001). Intraoperative transesophageal echocardiography (TEE) was utilized in 77.6% of patients with level III thrombus extension and in 100% of patients with level IV thrombus extension. Intraoperative TEE guidance resulted in a significant surgical plan modification in 3 cases (5.2%). Short-term mortality was low (n = 3, 4.3%). Conclusions Utilization of specialized liver transplantation and cardiac surgical techniques in the resection of RCC with extension into the IVC calls for a close intra-and interdepartmental collaboration between surgeons and anesthesiologists. The transabdominal approach to suprahepatic segments of the IVC allowed avoidance of extracorporeal circulatory support in most of these patients. Perioperative management of these patients reflected the critical importance of TEE-proficient practitioners experienced in liver transplantation and cardiac anesthesia.

Original languageEnglish
Pages (from-to)640-646
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume28
Issue number3
DOIs
StatePublished - Jan 1 2014

Fingerprint

Heart Neoplasms
Inferior Vena Cava
Renal Cell Carcinoma
Thrombosis
Anesthesia
Transplants
Liver
Transesophageal Echocardiography
Liver Transplantation
Medical Records
Neoplasms
Mortality
Research Ethics Committees
Heart Transplantation
Chi-Square Distribution
Cardiopulmonary Bypass
Tertiary Care Centers
Length of Stay
Analysis of Variance
Retrospective Studies

Keywords

  • cardiac anesthesia
  • invasion of inferior vena cava
  • liver transplant
  • renal cell carcinoma
  • transesophageal echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Invasive renal cell carcinoma with inferior vena cava tumor thrombus : Cardiac anesthesia in liver transplant settings. / Fukazawa, Kyota; Gologorsky, Edward; Naguit, Kirstin; Pretto, Ernesto; Salerno, Tomas; Arianayagam, Mohan; Silverman, Richard; Barron, Michael; Ciancio, Gaetano.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 28, No. 3, 01.01.2014, p. 640-646.

Research output: Contribution to journalArticle

@article{888bb39379ec4fe5befacd8ec467823b,
title = "Invasive renal cell carcinoma with inferior vena cava tumor thrombus: Cardiac anesthesia in liver transplant settings",
abstract = "Objectives Resection of renal cell carcinomas (RCC) with tumor thrombus invasion into the inferior vena cava (IVC) is associated with significant perioperative morbidity and mortality. This study examined the intra- and inter-departmental collaboration among cardiac, liver transplantation, and urologic surgeons and anesthesiologists in caring for these patients. Design After IRB approval, medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010 in this institution, were reviewed. Data were collected and analyzed by one way-ANOVA and chi-square test. Setting Major academic institution, tertiary referral center. Participants This was a retrospective study based on the medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010. Interventions None. Measurements and Main Results Fifty-eight patients (82.9{\%}) with level III thrombus and 12 patients (17.1{\%}) with level IV thrombus were analyzed. Sixty-five (92.9{\%}) did not require any extracorporeal circulatory support; 5 (2 with level III and 3 with level IV; 7.1{\%}) required cardiopulmonary bypass. No patients required veno-venous bypass. Compared to patients with level III thrombus extension, patients with level IV had higher estimated blood loss (6978±2968 mL v 1540±206, p<0.001) and hospital stays (18.8±1.6 days v 8.1±0.7, p<0.001). Intraoperative transesophageal echocardiography (TEE) was utilized in 77.6{\%} of patients with level III thrombus extension and in 100{\%} of patients with level IV thrombus extension. Intraoperative TEE guidance resulted in a significant surgical plan modification in 3 cases (5.2{\%}). Short-term mortality was low (n = 3, 4.3{\%}). Conclusions Utilization of specialized liver transplantation and cardiac surgical techniques in the resection of RCC with extension into the IVC calls for a close intra-and interdepartmental collaboration between surgeons and anesthesiologists. The transabdominal approach to suprahepatic segments of the IVC allowed avoidance of extracorporeal circulatory support in most of these patients. Perioperative management of these patients reflected the critical importance of TEE-proficient practitioners experienced in liver transplantation and cardiac anesthesia.",
keywords = "cardiac anesthesia, invasion of inferior vena cava, liver transplant, renal cell carcinoma, transesophageal echocardiography",
author = "Kyota Fukazawa and Edward Gologorsky and Kirstin Naguit and Ernesto Pretto and Tomas Salerno and Mohan Arianayagam and Richard Silverman and Michael Barron and Gaetano Ciancio",
year = "2014",
month = "1",
day = "1",
doi = "10.1053/j.jvca.2013.04.002",
language = "English",
volume = "28",
pages = "640--646",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - Invasive renal cell carcinoma with inferior vena cava tumor thrombus

T2 - Cardiac anesthesia in liver transplant settings

AU - Fukazawa, Kyota

AU - Gologorsky, Edward

AU - Naguit, Kirstin

AU - Pretto, Ernesto

AU - Salerno, Tomas

AU - Arianayagam, Mohan

AU - Silverman, Richard

AU - Barron, Michael

AU - Ciancio, Gaetano

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives Resection of renal cell carcinomas (RCC) with tumor thrombus invasion into the inferior vena cava (IVC) is associated with significant perioperative morbidity and mortality. This study examined the intra- and inter-departmental collaboration among cardiac, liver transplantation, and urologic surgeons and anesthesiologists in caring for these patients. Design After IRB approval, medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010 in this institution, were reviewed. Data were collected and analyzed by one way-ANOVA and chi-square test. Setting Major academic institution, tertiary referral center. Participants This was a retrospective study based on the medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010. Interventions None. Measurements and Main Results Fifty-eight patients (82.9%) with level III thrombus and 12 patients (17.1%) with level IV thrombus were analyzed. Sixty-five (92.9%) did not require any extracorporeal circulatory support; 5 (2 with level III and 3 with level IV; 7.1%) required cardiopulmonary bypass. No patients required veno-venous bypass. Compared to patients with level III thrombus extension, patients with level IV had higher estimated blood loss (6978±2968 mL v 1540±206, p<0.001) and hospital stays (18.8±1.6 days v 8.1±0.7, p<0.001). Intraoperative transesophageal echocardiography (TEE) was utilized in 77.6% of patients with level III thrombus extension and in 100% of patients with level IV thrombus extension. Intraoperative TEE guidance resulted in a significant surgical plan modification in 3 cases (5.2%). Short-term mortality was low (n = 3, 4.3%). Conclusions Utilization of specialized liver transplantation and cardiac surgical techniques in the resection of RCC with extension into the IVC calls for a close intra-and interdepartmental collaboration between surgeons and anesthesiologists. The transabdominal approach to suprahepatic segments of the IVC allowed avoidance of extracorporeal circulatory support in most of these patients. Perioperative management of these patients reflected the critical importance of TEE-proficient practitioners experienced in liver transplantation and cardiac anesthesia.

AB - Objectives Resection of renal cell carcinomas (RCC) with tumor thrombus invasion into the inferior vena cava (IVC) is associated with significant perioperative morbidity and mortality. This study examined the intra- and inter-departmental collaboration among cardiac, liver transplantation, and urologic surgeons and anesthesiologists in caring for these patients. Design After IRB approval, medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010 in this institution, were reviewed. Data were collected and analyzed by one way-ANOVA and chi-square test. Setting Major academic institution, tertiary referral center. Participants This was a retrospective study based on the medical records of patients who underwent resection of RCC tumor thrombus level III and IV, from 1997 to 2010. Interventions None. Measurements and Main Results Fifty-eight patients (82.9%) with level III thrombus and 12 patients (17.1%) with level IV thrombus were analyzed. Sixty-five (92.9%) did not require any extracorporeal circulatory support; 5 (2 with level III and 3 with level IV; 7.1%) required cardiopulmonary bypass. No patients required veno-venous bypass. Compared to patients with level III thrombus extension, patients with level IV had higher estimated blood loss (6978±2968 mL v 1540±206, p<0.001) and hospital stays (18.8±1.6 days v 8.1±0.7, p<0.001). Intraoperative transesophageal echocardiography (TEE) was utilized in 77.6% of patients with level III thrombus extension and in 100% of patients with level IV thrombus extension. Intraoperative TEE guidance resulted in a significant surgical plan modification in 3 cases (5.2%). Short-term mortality was low (n = 3, 4.3%). Conclusions Utilization of specialized liver transplantation and cardiac surgical techniques in the resection of RCC with extension into the IVC calls for a close intra-and interdepartmental collaboration between surgeons and anesthesiologists. The transabdominal approach to suprahepatic segments of the IVC allowed avoidance of extracorporeal circulatory support in most of these patients. Perioperative management of these patients reflected the critical importance of TEE-proficient practitioners experienced in liver transplantation and cardiac anesthesia.

KW - cardiac anesthesia

KW - invasion of inferior vena cava

KW - liver transplant

KW - renal cell carcinoma

KW - transesophageal echocardiography

UR - http://www.scopus.com/inward/record.url?scp=84902261985&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902261985&partnerID=8YFLogxK

U2 - 10.1053/j.jvca.2013.04.002

DO - 10.1053/j.jvca.2013.04.002

M3 - Article

C2 - 24050854

AN - SCOPUS:84902261985

VL - 28

SP - 640

EP - 646

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 3

ER -