PD35-06 VENA CAVOSCOPY IN THE ASSESSMENT OF INTRALUMINAL VENA CAVAL TUMOR INVOLVEMENT

Abstract

You have accessJournal of UrologyKidney Cancer: Advanced I1 Apr 2015PD35-06 VENA CAVOSCOPY IN THE ASSESSMENT OF INTRALUMINAL VENA CAVAL TUMOR INVOLVEMENT Jeffrey Loh-Doyle, Sumeet Syan-Bhanvadia, Eli Thompson, Mukul Patil, Hooman Djaladat, and Siamak Daneshmand Jeffrey Loh-DoyleJeffrey Loh-Doyle More articles by this author , Sumeet Syan-BhanvadiaSumeet Syan-Bhanvadia More articles by this author , Eli ThompsonEli Thompson More articles by this author , Mukul PatilMukul Patil More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2229AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with renal cell carcinoma (RCC) and testicular cancer (TC) with associated inferior vena caval tumor involvement often benefit from aggressive surgical resection of the primary tumor and associated tumor thrombus. Due to the nature of the location, resection of tumor thrombus extension cephalad to the infrahepatic IVC represents a unique technical challenge. This is particularly evident when the tumor thrombus is friable or involves the hepatic veins. We report on our experience using intraoperative vena cavoscopy with a flexible cystoscope to ascertain the completeness of tumor thrombus resection. METHODS From 2006-2014, 32 patients underwent retroperitoneal surgery with IVC tumor thrombectomy and vena cavoscopy. All patients with supradiaphragmatic (17 RCC), intrahepatic (9 RCC, 1 TC), or infrarenal tumor thrombus (3 RCC, 2 TC) underwent continuous intraoperative transesophageal echocardiography to assess for cardiac changes and to evaluate the extent of the tumor thrombus. Immediately after surgical resection a flexible cystoscope is inserted into the vena cava for direct visual inspection of the caval lumen with high flow heparinized saline irrigation. Perioperative outcomes including estimated blood loss, transfusion requirements, residual tumor, changes in management due to findings at cavoscopy, and postoperative complications were analyzed. RESULTS All patients underwent endoscopy of the vena caval lumen without complications. 8 of 32 patients were found to have residual tumor thrombus upon visualization of the lumen. Of these, six patients were noted to have tumor invasion of the intraluminal wall resulting in cavectomy. Residual intraluminal tumor was noted in 2 patients which was bluntly resected with no residual tumor visible on repeat endoscopy. Median estimated blood loss was 3L (0.5-16) with a median intraoperative transfusion requirement of 14 units (0-63 units). Median Pringle Maneuver time was 15 minutes (3-30 minutes). Median length of stay was 10 days (4-73 days). Postoperative lower extremity edema was noted in 5 patients (3 following cavectomy) with resolution in all patients and a median resolution time of 52 days (30-322 days). There were no complications associated with vena cavoscopy. CONCLUSIONS Vena Cavoscopy using a flexible cystoscope is an expedient and feasible technique that may be utilized intra-operatively in order to ensure clearance of residual thrombus burden within the inferior vena cava or hepatic veins and to assess for caval wall invasion. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e761-e762 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Loh-Doyle More articles by this author Sumeet Syan-Bhanvadia More articles by this author Eli Thompson More articles by this author Mukul Patil More articles by this author Hooman Djaladat More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...