The role of transesophageal echocardiography in the management of renal cell carcinoma with venous tumor thrombus
Autor: | Stephen H. Gray, Benjamin C. Tuck, Carli E Calderone, Soroush Rais-Bahrami, Kristin K. Porter |
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Rok vydání: | 2018 |
Předmět: |
medicine.medical_specialty
030232 urology & nephrology Vena Cava Inferior 030204 cardiovascular system & hematology Inferior vena cava Surgical planning law.invention 03 medical and health sciences 0302 clinical medicine Tumor thrombus law Renal cell carcinoma medicine Cardiopulmonary bypass Vascular clamp Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Thrombus Carcinoma Renal Cell Thrombectomy Venous Thrombosis Surgical complication business.industry medicine.disease Neoplastic Cells Circulating Kidney Neoplasms medicine.vein cardiovascular system Radiology Cardiology and Cardiovascular Medicine business human activities Echocardiography Transesophageal |
Zdroj: | Echocardiography (Mount Kisco, N.Y.). 35(12) |
ISSN: | 1540-8175 |
Popis: | We reviewed the role of transesophageal echocardiography (TEE) in the management of renal cell carcinoma (RCC) with associated tumor thrombus. Many consider intraoperative TEE as imperative in cases of Level 4 thrombi with atrial involvement, as well as in cases that require the use of cardiopulmonary bypass (CPB). However, the role of TEE in the surgical management of RCC with associated inferior vena cava (IVC) thrombus may expand beyond this subset. When performed after induction, TEE provides updated information regarding tumor thrombus staging, which is essential for optimal surgical planning. Furthermore, TEE provides feedback regarding properties of the thrombus, such as fragility and adherence, which may alter surgical technique. TEE can also be used intraoperatively for central venous line placement, to monitor cardiovascular and fluid status, to guide vascular clamp placement, and to ensure complete removal of the tumor thrombus. In some cases, the use of TEE allows for less morbid procedures and safe avoidance of CPB. We therefore recommend the use of preoperative TEE in all cases with a known tumor thrombus with discretion as to what extent TEE is used throughout the remainder of the case. Further investigation is necessary to elucidate the effect of TEE on patient outcomes, including surgical complication rates, morbidity and mortality of procedures, and cancer control. |
Databáze: | OpenAIRE |
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