Role of transoesophageal echocardiography in renal cell carcinoma: a brief review

Abstract

Transoesophageal echocardiography (TOE) is regularly used in cardiac and also increasingly in non-cardiac surgeries. It has a leading role in the perioperative management of renal cell carcinoma with tumour extension into inferior vena cava. We report two cases in which TOE was of immense help for patient management. This report highlights the two cases where intraoperative TOE was of immense help to establish diagnosis, to modify surgical plan, to guide the surgeon during clamp placement, to monitor cardiac function, to rule out tumour embolism and to confirm the complete removal of tumour thrombus.

The role of intraoperative transesophageal echocardiography in the management of renal cell carcinoma with atrial thrombus – case report

“…Nevertheless, TEE can accurately define the cranial extent of tumor thrombus, and its diagnostic utility increases with the level of tumor thrombus extension ( 7 ) . At the stage of surgical planning, it helps to assess the nature of tumor thrombus, which includes size, consistency, fragility, adherence, and mobility ( 8 ) . Two main types of tumor thrombi are distinguished: solid, small atrial thrombus (case 1) and fragile or adherent thrombus that fills a large capacity of the RA (case 2).…”

“…In the transabdominal approach, it guides the surgeon and prevents applying the vascular clamp to a portion of the IVC with the thrombus, which can result in embolization. Furthermore, it helps to rule out or confirm the presence of residual tumor thrombus in the IVC or in the RA, thus providing evidence of complete resection ( 8 ) .…”

Transgastric Abdominal Ultrasonography in Anesthesia and Critical Care: Review and Proposed Approach

“…Some authors have suggested that TGAUS can provide real-time assessment of the mobility, fragility, and degree of IVC invasion by the tumor or risk of embolization into the right atrium using the Neves and Zincke classification of renal cell carcinoma. 43,45,50,51,66,123,124 Tumors can evolve between the time of preoperative testing and the day of surgery; TGAUS is, therefore, considered an important tool to accurately locate the tumor intraoperatively, which will improve surgical planning, 50,52,67,68 as well as guide and direct 69 catheter-guided 49 or robot-assisted thrombectomy. 70 Tumor resection may require clamping of the IVC, which dramatically affects preload.…”

“…51,67 Once the resection is complete, TGAUS can also be used to carefully examine the IVC for any residual tumor. 67 The intraoperative guidance afforded by TGAUS may allow for a less invasive catheter-based cavoatrial thrombectomy, thus sparing the patient from sternotomy, CPB, and its associated complications. 50,71,72…”

“…TGAUS is also a useful tool to differentiate hypotension due to changes in preload versus tumor embolization with resulting right ventricular failure and obstructive shock. 51,67 Once the resection is complete, TGAUS can also be used to carefully examine the IVC for any residual tumor. 67 The intraoperative guidance afforded by TGAUS may allow for a less invasive catheter-based cavoatrial thrombectomy, thus sparing the patient from sternotomy, CPB, and its associated complications.…”