Perioperative anesthetic management for renal cell carcinoma with vena caval thrombus extending into the right atrium: case series.
Renal cell carcinoma has a tendency for vascular invasion and may extend into the inferior vena cava and even into the right-sided cardiac chambers. It has been reported that nephrectomy with thrombectomy can provide immediate palliation of symptoms with 5-year survival rates of up to 72% in the absence of nodal or distant metastasis. The location of the tumor dictates the anesthetic and surgical approach, as extension into the heart often necessitates cardiac surgical involvement. Renal cell carcinoma with vena cava tumor thrombus extending into the right cardiac chamber usually requires cardiopulmonary bypass and occasionally deep hypothermic circulatory arrest for surgical resection, and anesthetic approach should be tailored to each individual case. Thorough preoperative evaluation and the commitment of a multidisciplinary surgery team are indispensable.
Department of Anesthesia, Indiana University School of Medicine, Fesler Hall Room 204, 1130 West Michigan St, Indianapolis, IN, 46202-5115. Electronic address: moritay@iupui.edu.
Yoshihisa
Y
Morita
Cardiac Surgery Intensive Care Unit, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center Heart Institute, 127 San Vicente Blvd Suite 3100, Los Angeles, CA, 90048.
Kengo
K
Ayabe
Cardiac Surgery Intensive Care Unit, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center Heart Institute, 127 San Vicente Blvd Suite 3100, Los Angeles, CA, 90048.
Michael
M
Nurok
Department of Anesthesia, Indiana University School of Medicine, Fesler Hall Room 204, 1130 West Michigan St, Indianapolis, IN, 46202-5115.
Jerry
J
Young
D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D017548:Echocardiography, Transesophageal; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D017131:Thrombectomy / Q000379:methods; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology*
Cardiopulmonary bypass; Renal cell carcinoma; Tee; Tumor thrombus