Invasive Renal Cell Carcinoma with Inferior Vena Cava Tumor Thrombus: Cardiac Anesthesia in Liver Transplant Settings

• Published in: Journal of cardiothoracic and vascular anesthesia 2014-06, Vol.28 (3), p.640-646
• Main Authors: Fukazawa, Kyota, MD, Gologorsky, Edward, MD, FASE, Naguit, Kirstin, MBBS, FANZCA, Pretto, Ernesto A., MD, MPH, Salerno, Tomas A., MD, Arianayagam, Mohan, FRACS, Silverman, Richard, MD, Barron, Michael E., MD, FAHA, Ciancio, Gaetano, MD
• Format: Article
• Language: English
• Subjects: Anesthesia & Perioperative Care; Anesthesia - methods; Carcinoma, Renal Cell - complications; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - surgery; cardiac anesthesia; Critical Care; Echocardiography, Transesophageal; Female; Humans; invasion of inferior vena cava; Kidney Neoplasms - complications; Kidney Neoplasms - surgery; liver transplant; Liver Transplantation - methods; Male; Middle Aged; Nephrectomy; Perioperative Care; renal cell carcinoma; Retrospective Studies; Thrombosis - etiology; Thrombosis - mortality; Thrombosis - surgery; transesophageal echocardiography; Treatment Outcome; Vena Cava, Inferior - surgery
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2013.04.002

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