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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (4): 631-635. doi: 10.19723/j.issn.1671-167X.2024.04.014

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Clinical effects of transesophageal echocardiography in different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ vena tumor thrombectomy

Jie YANG1,Jieli FENG1,*(),Shudong ZHANG2,Lulin MA2,Qing ZHENG3   

  1. 1. Department of Cardiology, Peking University Third Hospital, Beijing 100191, China
    2. Department of Urology, Peking University Third Hospital, Beijing 100191, China
    3. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
  • Received:2024-03-13 Online:2024-08-18 Published:2024-07-23
  • Contact: Jieli FENG E-mail:jielifengtt@163.com
  • Supported by:
    the Haidian Innovation and Transformation Special Science and Technology Innovation Research and Development Program(2022Y78475-06)

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Abstract:

Objective: To analyze the clinical effects of intraoperative transesophageal echocardiography (TEE) in different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ inferior vena cave (IVC) tumor thrombectomy. Methods: In the study, 28 patients who did surgery of nephrectomy and Mayo Ⅲ-Ⅳ IVC thrombectomys in Peking University Third Hospital from 2022 January to 2024 February were included. Of the 28 patients, 16 patients did robotic surgery, 2 patients did laparoscopic surgery, and 10 patients did open surgery. All patients' clinical data were collected. Results: Intra-operative TEE was used in 9 robotic surgeries, of which 7 cases showed image changes compared with preoperative image results. Intraoperative TEE indicated that tumor thrombus entered the right atrium in 2 cases, showed that tumor thrombus grade rose from Mayo Ⅲ to Mayo Ⅳ in 2 cases, and indicated that tumor thrombus adhered to IVC wall in 3 cases. All of these surgical plans were timely adjusted. Intra-operative TEE was used in 6 cases of open surgery, and 4 cases of them showed Mayo grade changes compared with preoperative image results. Intraoperative TEE indicated that tumor thrombus adhered to the IVC wall in 3 cases, and tumor thrombus adhered to the IVC wall with thrombus in one case. The surgical plans were adjusted, and the tumor thrombus was left or segmentally removed. Laparoscopic surgery did not use intraoperative TEE. The effects of intraoperative TEE included: the combination of exploration and TEE monitoring was used in open surgery, and tumor thrombus removal process was fully monitored by intraoperative TEE in the robotic surgery. Intraoperative TEE real-time monitored circulatory status and cardiac function changes. Conclusion: In different surgical methods for nephrectomy combined with Mayo Ⅲ-Ⅳ tumor thrombectomy, intraoperative TEE can re-determine the tumor thrombus grade and degree of tumor thrombus adhered to IVC, track the tumor thrombus removal process in real-time, and monitor circulatory status and cardiac function changes. Intraoperative TEE plays an important role in different surgical methods, but its clinical application is still insufficient. Intraoperative TEE is recommended to such type of surgeries.

Key words: Transesophageal echocardiography, Mayo Ⅲ-Ⅵ tumor thrombus, Nephrectomy, Tumor thrombectomy

CLC Number: 

  • R737.11

Table 1

Clinical features of 28 patients with nephrectomy combined with Mayo Ⅲ-Ⅳ vena tumor thrombectomy"

Items Robotic operation (n=16) Laparoscope urgery (n=2) Open surgery (n=10)
Age/years 58 (30-77) 71 (64-78) 57 (41-73)
Male 10 (62.5) 1 (50.0) 5 (50.0)
Left kidney removal 4 (25.0) 0 (0) 2 (20.0)
Time of surgery/min 249 (118-549) 219 (150-287) 350 (128-616)
Operative bleeding volume/mL 823 (50-3 000) 300 (200-400) 2 460 (400-12 000)
IVC obstrustion time/min 18 (7-28) 21 (19-23) 28 (12-50)
IVC tumor thrombus adhesion 7 (43.8) 0 (0) 6 (60.0)
IVC reconstruction method
  Incise and stitch 10 (62.5) 2 (100.0) 5 (50.0)
  Segmental resection 6 (37.5) 0 (0) 3 (30.0)
  Left/segmental removed 0 (0) 0 (0) 2 (20.0)
IVC tumor thrombectomy method
  Incise removal 10 (62.5) 2 (100.0) 5 (50.0)
  Foley draging 6 (37.5) 0 (0) 2 (20.0)
  Milking 0 (0) 0 (0) 1 (10.0)
Tumor thrombus falling off during operation 1 (6.3) 0 (0) 0 (0)
ARHF during operation 1 (6.3) 0 (0) 0 (0)
Mayo Ⅲ tumor thrombus 11 (68.8) 2 (100.0) 9 (90.0)
Mayo Ⅳ tumor thrombus 5 (31.2) 0 (0) 1 (10.0)
Intraoperative TEE 9 (56.3) 0 (0) 6 (60.0)
Intraoperative Mayo grade change by TEE diagnose 7 (43.8) 0 (0) 4 (40.0)

Figure 1

Intraoperative TEE indicated that IVC tumor thrombus entering the right atrium TEE, transesophageal echocardiography; IVC, inferior vena cave."

Figure 2

Kidney tumor and thrombus TEE, transesophageal echocardiography; IVC, inferior vena cave."

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