Sema TURAN, Şerife GÖKBULUT BEKTAŞ, Mine ALTINKAYA ŞAVUŞ

Kısmi kardiyopulmoner baypas sırasında renal kavoatriyal tümör trombozunun anestezi yönetimi

Elli sekiz yaşında erkek hastada kardiyopulmoner baypas sırasında dolaşım arresti olmaksızın kavoatriyal trombus ve renal tümörlerin cerrahi olarak çıkarılması planlandı. Ameliyat süresince transözofageal ekokardiyografi ile pulmoner emboli açısından sürekli takip yapıldı. Ameliyat anesteziyoloji uzmanları, üroloji uzmanları ve kalp damar ve gastrointestinal cerrahlarından oluşan multidisipliner bir ekip tarafından başarıyla gerçekleştirildi. Bu olgu, kavoatriyal trombüslü renal hücreli karsinom hastalarında anestezi yönetiminin önemini göstermektedir

Anesthetic management of renal cavoatrial tumor thrombus during partial cardiopulmonary bypass

A 58-year-old male patient was scheduled for the surgicalremoval of a cavoatrial thrombus and renal tumors duringcardiopulmonary bypass without circulatory arrest. Throughoutthe operation, continuous monitoring for pulmonary embolismwas carried out by transesophageal echocardiography.A multidisciplinary team including anesthetists, urologists,and cardiovascular and gastrointestinal surgeons performedthe operation successfully. This case report highlights theimportance of anesthetic management in renal-cell carcinomapatients with a cavoatrial thrombus.

PDF

___

Hayashi J, Ohzeki H, Tsuchida S, Fujita Y, Tatebe S, Namura O, et al. Surgery for cavoatrial extension of malignant tumors. Thorac Cardiovasc Surg 1995;43:161-4.
Stief CG, Schäfers HJ, Kuczyk M, Anton P, Pethig K, Truss MC, et al. Renal-cell carcinoma with intracaval neoplastic extension: stratification and surgical technique. World J Urol 1995;13:166-70.
Matthews PN, Evans C, Breckenridge IM. Involvement of the inferior vena cava by renal tumour: surgical excision using hypothermic circulatory arrest. Br J Urol 1995;75:441-4.
Tongaonkar HB, Dandekar NP, Dalal AV, Kulkarni JN, Kamat MR. Renal cell carcinoma extending to the renal vein and inferior vena cava: results of surgical treatment and prognostic factors. J Surg Oncol 1995;59:94-100.
Lawindy SM, Kurian T, Kim T, Mangar D, Armstrong PA, Alsina AE, et al. Important surgical considerations in the management of renal cell carcinoma (RCC) with inferior vena cava (IVC) tumour thrombus. BJU Int 2012;110:926-39.
Morita Y, Ayabe K, Nurok M, Young J. Perioperative anesthetic management for renal cell carcinoma with vena caval thrombus extending into the right atrium: case series. J Clin Anesth 2017;36:39-46.
Erdemli Ö, Demir A, Güçlü ÇY, Karadeniz Ü, Çağli K. Thrombi migration to atrium diagnosed by transesophageal echocardiography. Asian Cardiovasc Thorac Ann 2013;21:467-9.
Ciancio G, Vaidya A, Savoie M, Soloway M. Management of renal cell carcinoma with level III thrombus in the inferior vena cava. J Urol 2002;168:1374-7.
Tribble CG, Gerkin TM, Flanagan TL, Pitman JM, Kron IL. Vena caval involvement with renal tumors: surgical considerations. Ann Thorac Surg 1988;46:36-9.
Glazer AA, Novick AC. Long-term followup after surgical treatment for renal cell carcinoma extending into the right atrium. J Urol 1996;155:448-50.
Welz A, Schmeller N, Schmitz C, Reichart B, Hofstetter A. Resection of hypernephromas with vena caval or right atrial tumor extension using extracorporeal circulation and deep hypothermic circulatory arrest: a multidisciplinary approach. Eur J Cardiothorac Surg 1997;12:127-32.
Treiger BF, Humphrey LS, Peterson CV Jr, Oesterling JE, Mostwin JL, Reitz BA, et al. Transesophageal echocardiography in renal cell carcinoma: an accurate diagnostic technique for intracaval neoplastic extension. J Urol 1991;145:1138-40.
Chen H, Ng V, Kane CJ, Russell IA. The role of transesophageal echocardiography in rapid diagnosis and treatment of migratory tumor embolus. Anesth Analg 2004;99:357-9.
Eyre RC, Hurley LJ, Burger AJ, Lewis KP. Use of dynamic two-dimensional transesophageal echocardiography for renal cell carcinoma with cavoatrial tumor thrombus. Urol Int 1995;54:132-6.
Koide Y, Mizoguchi T, Ishii K, Okumura F. Intraoperative management for removal of tumor thrombus in the inferior vena cava or the right atrium with multiplane transesophageal echocardiography. J Cardiovasc Surg (Torino) 1998;39:641-7.
Sigman DB, Hasnain JU, Del Pizzo JJ, Sklar GN. Realtime transesophageal echocardiography for intraoperative surveillance of patients with renal cell carcinoma and vena caval extension undergoing radical nephrectomy. J Urol 1999;161:36-8.
Glazer A, Novick AC. Preoperative transesophageal echocardiography for assessment of vena caval tumor thrombi: a comparative study with venacavography and magnetic resonance imaging. Urology 1997;49:32-4.
Tanaka Y, Kawaguchi M, Sha K, Kitaguchi K, Furuya H. Combined use of transesophageal echocardiography and basket catheter can prevent tumor embolism in a patient with renal cell carcinoma. Anesthesiology 1998;89:1015-7.
Plowman AN, Bolsin SN, Patrick AJ. Unusual cause of intraoperative hypotension diagnosed with transoesophageal echocardiography in a patient with renal cell carcinoma. Anaesth Intensive Care 1999;27:63-5.
Yamashita C, Azami T, Okada M, Toyoda Y, Wakiyama H, Yoshida M, et al. Usefulness of cardiopulmonary bypass in reconstruction of inferior vena cava occupied by renal cell carcinoma tumor thrombus. Angiology 1999;50:47-53.
Chan F, Ngan Kee WD, Low JM. Anesthetic management of renal cell carcinoma with inferior vena caval extension. J Clin Anesth 2001;13:585-7.
Fukazawa K, Gologorsky E, Naguit K, Pretto EA Jr, Salerno TA, Arianayagam M, et al. Invasive renal cell carcinoma with inferior vena cava tumor thrombus: cardiac anesthesia in liver transplant settings. J Cardiothorac Vasc Anesth 2014;28:640-6.