Defining the Role of Intraoperative Transesophageal Echocardiography During Radical Nephrectomy With Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma

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Abstract

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.

Original languageEnglish (US)
JournalUrology
DOIs
StateAccepted/In press - 2017

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Thrombectomy
Transesophageal Echocardiography
Inferior Vena Cava
Nephrectomy
Renal Cell Carcinoma
Thrombosis
Neoplasms
Echocardiography
Venae Cavae
Decision Making
Anesthesia

ASJC Scopus subject areas

  • Urology

Cite this

@article{ff99d7c275964b9dbfb1e35f14fa233f,
title = "Defining the Role of Intraoperative Transesophageal Echocardiography During Radical Nephrectomy With Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma",
abstract = "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.",
author = "Megan Kostibas and Vivek Arora and Michael Gorin and Ball, {Mark W.} and Pierorazio, {Phillip Martin} and Allaf, {Mohamad E} and Daniel Nyhan and Brady, {Mary Beth}",
year = "2017",
doi = "10.1016/j.urology.2017.03.008",
language = "English (US)",
journal = "Urology",
issn = "0090-4295",
publisher = "Elsevier Inc.",

}

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T1 - Defining the Role of Intraoperative Transesophageal Echocardiography During Radical Nephrectomy With Inferior Vena Cava Tumor Thrombectomy for Renal Cell Carcinoma

AU - Kostibas, Megan

AU - Arora, Vivek

AU - Gorin, Michael

AU - Ball, Mark W.

AU - Pierorazio, Phillip Martin

AU - Allaf, Mohamad E

AU - Nyhan, Daniel

AU - Brady, Mary Beth

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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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