Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus: A case report

Table 1 Summary of reported cases of Ewing’s sarcoma rising from the adrenal gland with inferior vena cava tumor thrombus

No	Ref.	Age	Gender	Position	Tumor size, cm	Initial infiltration or metastasis	Surgical procedure	Outcome at time of report
1	Zhang et al[14]	30	M	R	12	IVC tumor thrombus	Adr	Dead (8 mo)
2	Zhang et al[14]	22	M	L	17	IVC tumor thrombus	Adr + Neph + Spl + IVCt	Alive
3	Abi-Raad et al[4]	26	F	L	11.3	IVC tumor thrombus	Adr + Neph + Spl + IVCt	Alive (8 mo)
4	Kim et al[15]	25	F	L	15.2	lung, IVC, RA tumor thrombus	NR	NR
5	Saboo et al[16]	26	F	L	Large	IVC tumor thrombus	No surgery	NR
6	Present case	20	F	R	22	Liver, IVC, RA tumor thrombus	Liver + Adr + IVCt + RAt	Alive

F: Female; M: Male; L: Left; R: Right; Adr: Adrenalectomy; Neph: Nephrectomy; Spl: Splenectomy; IVCt: Inferior vena cava thrombectomy; RA: Right atrium; NR: Not recorded.

Table 2 Vital signs and ventilation parameters during surgery

Time point	Preoperative	After intubation	During dissociation	After CPB	After Surgery	After CPR
HR (bpm)	110	112	120	120	80	100
ABP (mmHg)	92/60	102/70	70/40	90/60	105/70	140/100
SpO2 (%)	90	98	100	100	100	100
CVP (cmH2O)	13	13	9	18	20	11
BIS	90	50	43	45	40	/

CPB: Cardiopulmonary bypass; CPR: Cardiopulmonary resuscitation; ABP: Arterial blood pressure; CVP: Central venous pressure; BIS: Bispectral index.

Table 3 Arterial gas analysis during surgery

Time point	After intubation	Before CPB	After CPB	Postoperative	After CPR
pH	7.29	7.20	7.32	7.46	7.35
PaO2 (mmHg)	198	385	372	419	370
PaCO2 (mmHg)	44	36	32	30	44
BE (mEq/L)	-5.9	-12.9	-4.5	-2.5	-1.9
Hb (g/L)	120	82	54	55	70
K+ (mmol/L)	4.3	5.6	4.7	3.8	4.4
HCO3- (mmol/L)	20.5	14	21.1	21.0	23.6
Glu (mmol/L)	4.7	8.4	7.8	7.2	8.7

CPB: Cardiopulmonary bypass; CPR: Cardiopulmonary resuscitation.

Table 4 Perioperative vital laboratory data

Time point	Preoperative	Postoperative	Discharged
Red blood cell ( × 109)	5.02	3.15	3.09
Hemoglobin (g/L)	113	96	94
White cell count ( × 109)	5.27	8.02	2.86
Neutrophils (%)	57.7	84.7	70
Lymphocytes (%)	22.7	11.1	8.5
Procalcitonin (ng/mL)	---	1.82	0.126
Platelets ( × 109)	113	63	156
APTT (s)	32	32.5	29.5
PT (s)	15.5	14.5	12.1
INR	1.45	1.36	1.21
Coagulation factor VIII (%)	---	94.2	150
D-dimer	---	8.31	2.78
Fibrinogen (g/L)	3.8	1.08	2.9

PCT: Procalcitonin.