Perioperative morbidity and mortality in dogs with invasive adrenal neoplasms treated by adrenalectomy and cavotomy

Abstract

Objective To report the morbidity and mortality associated with adrenalectomy with cavotomy for resection of invasive adrenal neoplasms in dogs and evaluate risk factors for perioperative outcomes. Study design Retrospective study. Animals Forty‐five client‐owned dogs. Methods Dogs that underwent open adrenalectomy with cavotomy for resection of adrenal masses with tumor thrombus extending into the vena cava were included. Clinicopathologic data were harvested from medical records. Selected clinical, imaging, and operative variables were statistically evaluated as risk factors for packed red blood cell transfusion, nephrectomy, perioperative death, and overall survival. Results Thirty‐six of 45 masses were pheochromocytomas, 7 were adrenocortical carcinomas, and 2 were unknown type. Caval thrombus terminated prehepatically in 21 of 45 dogs and extended beyond the porta hepatis but terminated prediaphragmatically (intrahepatic prediaphragmatic location) in 15 dogs and thrombi extended postdiaphragmatically in 5 dogs. Thirty‐four (76%) dogs were discharged from the hospital, and 11 (24%) dogs died or were euthanized prior to discharge. Median overall survival time for all 45 dogs was 547 days (95%CI 146–710). Bodyweight, tumor type, and size and extent of caval thrombus did not affect survival to discharge, but postdiaphragmatic (rather than prediaphragmatic) thrombus termination was associated with a greater risk of death. Conclusion Long‐term survival was common in dogs that survived the perioperative period. Postdiaphragmatic thrombus extension affected the prognosis for overall survival. Clinical significance Findings of this study help to stratify operative risk in dogs with adrenal neoplasia and caval invasion.

Outcome in dogs undergoing adrenalectomy for small adrenal gland tumours without vascular invasion

“…1,[3][4][5]11,12 A recent study revealed that adrenalectomy with cavotomy for resection of tumour thrombus within the vena cava can be challenging and short-term mortality can be high. 17 The short-term mortality was influenced by pre-and postdiaphragmatic thrombus extension. Only 40% of dogs survived with post-diaphragmatic thrombus extension compared with 73 to 81% survival in dogs with a thrombus terminating pre-diaphragmatically.…”

“…This controversy is likely because of the high perioperative mortality rates previously reported in the veterinary literature 1,3,4,5,11,12 . A recent study revealed that adrenalectomy with cavotomy for resection of tumour thrombus within the vena cava can be challenging and short‐term mortality can be high 17 . The short‐term mortality was influenced by pre‐ and post‐diaphragmatic thrombus extension.…”

Use of Contrast-Enhanced Ultrasonography for the Characterization of Tumor Thrombi in Seven Dogs

“…In addition, CEUS is performed in real time and allow to monitor continuously the contrast distribution, whereas in CT the selection of the vascular phase, i.e., the timing of the acquisition compared to the intravenous injection of the contrast agent, can influence the detection of thrombosis [15]. In small animals CT, the limited spatial resolution and the possible presence of streamlining artifact could reduce the possibility to correctly diagnose thrombosis [23], and CT may also be unable to detect endothelial invasion or evaluate the risk of fragmentations, both important features for a correct surgical planning [10].…”

“…Fast and less invasive surgical techniques have been recently described in dogs with caval invasion, with good results [8,9], despite the presence of a post-hepatic thrombus or long caval occlusion time [9]. According to another recent study, dogs with post-diaphragmatic tumor thrombi still showed a worse prognosis [10]. Therefore, detection and characterization of tumor thrombi is of great importance in patients with primary tumors for both surgical planning and prognosis.…”

“…In dogs, the presence of thrombosis associated with adrenal and thyroid masses is most likely to be malignant, as these tumors have the tendency of invade the vessels and adjacent tissues [1][2][3][4][5][6][7]. Nevertheless, CEUS could be useful in these cases to confirm the anatomic continuity with the tumor and to assess the homogeneity of the tumor thrombus in order to anticipate the possibility of fragmentation, which could lead to pulmonary thromboembolism and/or could represent a surgical complication, as previously described [10]. Despite the high sensitivity and specificity of CT in detecting vascular invasion in dogs [11], this modality may not be performant in the characterization of the homogeneity of the thrombus and also for detection of potential endothelial invasion, because of frequent streamlining artefacts and lesser spatial resolution compared to CEUS.…”