Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma

Abstract

Our results suggest that not all patients with MRCC require preoperative embolization, because usage of modern hemostatic agents can be an alternative bleeding control method.

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

“…Only patients with hypervascular tumors determined as such using angiographic evidence derived definite benefits from PE in our analysis. In the study by Zaborovskii et al (4), tumor vascularity was evaluated by an interventional radiologist and classified into four grades (not hypervascular, mild, moderate, and severe) according to the severity of tumor blush and venous drainage. Clausen et al (15) graded the vascularity of the metastases, by visual evaluation of the intensity of tumor blush, as: no hypervascularity (equal to or less than adjacent vertebrae without tumor involvement), moderate hypervascularity, and pronounced hypervascularity.…”

“…The maleto-female ratio was approximately 1.5. Most studies included mixed tumors (determined via histology); four (4,10,12,22) focused on hypervascular tumors, especially RCC. In contrast, Yoo et al (16) performed research particularly on nonhypervascular tumors.…”

“…In contrast, Yoo et al (16) performed research particularly on nonhypervascular tumors. Rather than using traditional histology, the authors of four studies determined hypervascularity using pre-embolization angiography (4,5,12,15). The common materials used for embolization were gelatin sponge, polyvinyl alcohol particles, and metallic coils.…”

“…The current treatment paradigm utilizes PE mainly for hypervascular tumors such as metastases from RCC, HCC, and thyroid cancer (8). Several studies indicated that PE reduced IBL (5,(10)(11)(12)(13)(14), while others revealed no statistically significant difference in IBL between patients undergoing and those not undergoing PE (4,8,(15)(16)(17).…”

“…Cancers of various origins metastasize frequently to bone, and the spine is the most common location of bone metastases ( 1 , 2 ). To relieve pain, improve neurological function, and maintain spinal stability and local tumor control, surgical intervention is necessary for certain spinal metastases ( 1 , 3 , 4 ). However, such surgery carries a high risk of extreme intraoperative blood loss (IBL), especially for highly vascularized tumors ( 5 ).…”