Pre-operative Embolization of Primary and Secondary Bone Tumours is Safe and Effective: a Retrospective Study

Al-Hadithy, Nawfal; Gikas, Panagiotis D.; Perera, Jonathan R; Aston, Will; Pollock, Rob; Skinner, John; Lotzof, Kevin; Cannon, Steve; Briggs, Tim

doi:10.4021/wjon389w

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…Complications related to pre-operative TAE have been reported in the literature (28,29). We used the Society of Interventional Radiology guidelines in this study to understand the importance of complications related to the angiography procedure (20,21).…”

Section: Discussionmentioning

confidence: 99%

Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?

Çelebioğlu

Bilgiç

Merter

et al. 2021

Diagn Interv Radiol

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Renal cell carcinomas (RCCs) are one of the leading causes of cancer-related death worldwide (1). About one-third of RCCs are metastatic at initial diagnosis, and skeletal metastases are the second most frequent type of RCC metastases following lung metastases (43%) (2, 3). Surgical intervention is an option for the treatment of skeletal metastases of RCCs. Although local ablative therapies like thermal ablation may be preferred for tumors <3 cm, systemic chemotherapy and radiotherapy are other options for suitable patients (4). However, RCCs are usually chemo/radio-resistant (50%), and these treatment options are usually favored for palliative intent (3-5).The 5-year overall survival of patients with RCC bone metastases increases when surgical metastasectomy is performed (4). However, since RCC metastases in the skeletal system are usually hypervascular, the operative blood loss could be as high as 18500 mL, which could threaten patients' lives (6). Transarterial embolization (TAE) of bone tumors was first described in 1975 (7). The operative blood loss can be reduced by adequate devascularization after TAE of the bone metastases (8-11), and a blood loss of less than 3000 mL was defined as clinical success for spinal tumor surgeries (12). Selective TAE of bone metastases can be performed pre-operatively in a single session. Successful embolization can clarify the tumor margins from the surrounding tissue planes, simplifying surgical manipulation of the tumors. Thus, recurrence rates may be lower in patients undergoing this treatment PURPOSE Our purpose is to clarify the optimal timing of surgery after transarterial embolization (TAE) for renal cell carcinoma (RCC) bone metastases. METHODSThis retrospective study included 41 patients with RCC bone metastases embolized between 2013 and 2019. Different-sized particulate and/or liquid embolic agents were used for TAE. Embolizations were categorized into groups 1-3 according to the interval between TAE and surgery (group 1: <1 day, group 2: 1-3 days, group 3: >3 days). Degree of embolization after TAE was graded visually based on angiographic images (<50%, 50%-75%, 75%-90%, >90%). The relationship between the TAE-surgery interval and intraoperative blood loss (IBL) and the correlation between IBL and embolization grade were examined. Lesion sizes and the relationships among lesion localizations and contrast media usage, intervention time, and IBL were also analyzed. RESULTSForty-six pre-operative TAEs (single lesion at each session) were performed in this study (26 in group 1, 13 in group 2, 7 in group 3). Lesion sizes and distributions were similar between groups (p = 0.897); >75% devascularization was achieved in 40 (TAEs 86.96%), but the IBL showed no correlation with the embolization rate (r=0.032, p = 0.831). The TAE-surgery interval was 1-7 days. The median IBL in group 1 (750 mL; range, 150-3000 mL) was significantly lower than those in the other groups (p = 0.002). Contrast media usage (p = 0.482) and intervention times (p = 0.261) were similar for metastases...

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Section: Discussionmentioning

confidence: 99%

Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?

Çelebioğlu

Bilgiç

Merter

et al. 2021

Diagn Interv Radiol

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“…18 Retrospective EBL = 1100-2600 mL MBL = 1400 mL BT = 0-8 units Kobayashi et al [27] 2012 62 Retrospective EBL = 250-11000 mL MBL = 2554 mL BT = 0-28 units Al-Hadithy et al [20] 2011 26 Retrospective EBL = 100-1800 mL BT = 0-3 units Zhang et al [32] 2009 47 Retrospective EBL = 705 ± 120 mL BT = 689 ± 133 mL Lee et al [13] 2008 6 Prospective EBL = 200-830 mL BT = Nil Our study 2012-2013 26 (study group) Case control study For study group EBL = 250-2900 mL BT = 0-1400 mL 28 (control group)…”

Section: Ref Year No Of Patients Type Of Study Resultsmentioning

confidence: 99%

Preoperative embolization of primary bone tumors: A case control study

Jha

Sharma

Rastogi

et al. 2016

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AIM:To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time. METHODS:Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison. RESULTS:The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group Ⅰ, n = 26). Non-embolization group (group Ⅱ, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean Case Control Study ORIGINAL ARTICLEsurgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications. CONCLUSION:Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.

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“…Ще одним доказом ефективності доопераційної емболізації кісткових гіперваскуляризованих пухлин є дані щодо мінімізації періопераційної крововтрати та пов'язаних з цим ускладнень при проведенні доопераційної емболізації у 26 пацієнтів [10], зокрема у пацієнта з гемангіомою тіла хребця L2. Об'єм інтраопераційної крововтрати становив у середньому 200 мл.…”

Section: таблиця об'єм крововтрати за час хірургічного втручанняunclassified

Combined treatment of hypervascular spinal tumors. Our experience

Shchehlov¹,

Samonenko²,

Найда³

et al. 2020

Endovasc. Neurorad.

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Objective – to increase the feasibility and safety of surgical treatment and to achieve better clinical outcome in patients with hypervascular spine tumors by combining managed endovascular embolization followed by surgery.Materials and methods. We enrolled 10 patients (6 men and 4 women, the average age was 57 years) with hypervascular spinal tumors who underwent examination and treatment at SO «Scientific-Practical Center of Endovascular Neuroradiology of NAMS of Ukraine» during the period from 2015 to 2019. Five patients have aggressive vertebral hemangiomas (L1, L2, Th12, Th 7, Th 6) and 5 patients have metastases of renal cell carcinoma of the vertebrae (Th4, Th10, Th12, L3) were included. Medical history and neurological status were evaluated, but in all cases the clinical diagnosis was made according to MRI and spine CT. In addition, all patients underwent selective spinal angiography via transfemoral access at the level of the lesion and in at least two adjacent levels. All patients underwent endovascular embolization of the tumor as the first step and open surgery in the volume of biopsy, decompression, and stabilization of the spine in the second stage. The volume of blood loss in ml was estimated by the anesthesiologist.Results. According to the localization of the lesions, spinal angiography showed a high accumulation of contrast fluid in its structure, compared to surrounding tissues, in all cases. This is evidence of the presence of a hypervascular lesion. All patients underwent the combination treatment – preventive endovascular embolization followed by surgery. In 9 cases embolization was performed 24–36 hours before surgery. Due to the patient’s somatic condition, open surgery was delayed once by 5 days. The total embolization of the tumor vasculature in 7 cases was achieved, with a subtotal embolization in 3 cases. Partial embolization was performed in one case of aggressive hemangioma when the afferent was involved in the blood supply of the spinal artery. Reversible deeper neurologic deficits following embolization in 4 cases was observed. Two patients noticed the reduction of the pain immediately after embolization. Mean intraoperative blood loss was 500 ml during the second stage of treatment. Blood loss was 600 ml in the case of delayed surgery. In all cases, the control of bleeding didn’t interrupt adequate decompression and transpedicular stabilization if it was required, and none of the surgical stages were delayed or canceled because of bleeding. Residual bleeding persisted from the venous system and tumor-related tissues.Conclusions. Preoperative embolization of hypervascularized tumors is a safe and effective method to reduce perioperative hemorrhage, which in turn leads to the reduction of the duration of surgery, improves the visualization of the surgical field, allows the performance of all steps of open surgery and achieve a positive clinical result. The mean blood loss was lower compared to procedures without preoperative embolization, according to published papers on surgery of hypervascular spinal tumors. Embolic agents (mixture of Histoacryl and Lipiodol and polyvinyl alcohol (PVA)) have shown high efficacy to control arterial bleeding, with residual bleeding from the venous system.

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Pre-operative Embolization of Primary and Secondary Bone Tumours is Safe and Effective: a Retrospective Study

Cited by 6 publications

References 9 publications

Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?

Scheduling surgery after transarterial embolization: does timing make any difference to intraoperative blood loss for renal cell carcinoma bone metastases?

Preoperative embolization of primary bone tumors: A case control study

Combined treatment of hypervascular spinal tumors. Our experience

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