Inferior Vena Cava Tumor Thrombus Dynamics and Perioperative Pulmonary Embolism: A Single-Center Experience

OBJECTIVES:To analyze preoperative tumor thrombus progression and occurrence of perioperative pulmonary embolism (PE) in patients with inferior vena cava tumor thrombus resection.DESIGN:Retrospective analysis.SETTINGS:University of Washington Medical Center.PARTICIPANTS:Patients who had undergone inferior vena cava tumor resection with thrombectomy from 2014 to 2017.INTERVENTIONS:Analysis of demographic, perioperative, and outcome data. Variables were compared between groups according to the level of tumor thrombus, the timing of the preoperative imaging, and the occurrence of perioperative PE.MEASUREMENTS AND MAIN RESULTS:Incidence, outcomes, and variables associated with perioperative PE and sensitivity/specificity analyses for optimized preoperative imaging timing, broken into 7-day increments, were assessed. Fifty-six patients were included in this analysis. Perioperative PE was observed in 6 (11%) patients, intraoperatively in 5 patients and in the early postoperative period in 1 patient. Of the 5 patients with intraoperative PE, 2 died intraoperatively. Perioperative PE occurred in 1 patient with tumor thrombus level I, in 2 patients with level II, in 2 patients with level III, and in 1 patient with level IV. Risks of preoperative tumor thrombus progression were minimized if the imaging study was performed within 3 weeks for level I and II tumor thrombi and within 1 week for level III tumor thrombus.CONCLUSIONS:Perioperative PE was observed in patients with all levels of tumor thrombus. Fifty percent of perioperative PE were observed in patients with infrahepatic tumor thrombus. Post-imaging progression of tumor thrombus was unlikely if the surgery was performed within 3 weeks in patients with levels I or II tumor thrombus or within 1 week in patients with level III tumor thrombus.