An Interdisciplinary Approach Utilizing Transesophageal Echocardiogram to Intraoperative Management of Renal Cell Carcinoma with Inferior Vena Cava Invasion

Objective: Report experience of patients undergoing surgery for resection of renal cell carcinoma with inferior vena cava invasion and use of transesophageal echocardiogram (TEE). Design: Retrospective and observational study. Setting: Single large university hospital. Participants: The study comprised 55 consecutive who underwent resection of renal cell carcinoma. Interventions: A transesophageal echocardiogram was performed by cardiac anesthesiologists in high grade tumors. Measurements and Main Results: Twenty-two patients had tumor thrombi classified as level III, and 6 patients were classified as level IV. There was increased use of TEE for higher level of tumor thrombi. Conclusions: The surgical management of renal cell carcinoma with inferior vena cava tumor extension is complex. High-grade tumors require individualized treatment. Successful outcomes require collaboration between surgeons and anesthesiologists. Patients with level IIIb to IV tumor invasion benefit from TEE assessment and monitoring, which may be life-saving, and cardiac anesthesia should be involved in those types of cases. (C) 2019 Elsevier Inc. All rights reserved.