Renal artery embolization before radical nephrectomy for complex renal tumour: which are the true advantages?

Abstract

<jats:title>Abstract</jats:title><jats:sec id="j_med-2019-0095_s_006_w2aab3b7d191b1b6b1aab1c15b1Aa"><jats:title>Introduction</jats:title><jats:p>Renal artery embolization is performed before radical nephrectomy (RN) for renal mass in order to induce preoperative infarction and to facilitate surgical intervention through decrease of intraoperative bleeding. Moreover, in metastatic renal cancer it seems to stimulate tumour-specific antibodies, even if no established benefits in clinical response or survival have been reported. The role of preoperative renal artery embolization (PRAE) in management of renal masses has been often debated and its real benefits are still unclear. Nevertheless, in huge and complex renal masses, which are often characterized by a high and anarchic blood supply and rapid local invasion, radical nephrectomy can be challenging even for skilled surgeons. The aim of this prospective randomized study was to evaluate the effectiveness and safety of PRAE in complex masses by comparing perioperative outcomes of RN with and without PRAE.</jats:p></jats:sec><jats:sec id="j_med-2019-0095_s_007_w2aab3b7d191b1b6b1aab1c15b2Aa"><jats:title>Materials and methods</jats:title><jats:p>From December 2015 to May 2018 we enrolled prospectively 64 patients who underwent RN for localized (T2a-b) or locally advanced (T3 and T4) or advanced (N+, M+) renal cancers. Patients were divided in two groups. The first group included 30 patients who underwent PRAE; in the second group we enrolled 34 patients who did not undergo RN without PRAE. Perioperative outcomes in terms of operative time, blood loss, transfusion rate and length of hospitalization were evaluated. Statistical analysis was performed using GraphPad Prism 6.0 software.</jats:p></jats:sec><jats:sec id="j_med-2019-0095_s_008_w2aab3b7d191b1b6b1aab1c15b3Aa"><jats:title>Results</jats:title><jats:p>Median blood loss was 250 ml (50-500) and 400 ml (50-1000) in the first and second group, respectively, with a statistically significant difference (p=0.0066). Median surgical time was 200 min (90-390) and 240 min (130-390) in PRAE and No-PRAE group (p=0.06), respectively. No major complications occurred after embolization. Overall complication rate in Group 1 and 2 was 46.7% (14/30) and 50% (17/34), respectively (p=0.34). No major complications occurred in both groups. The mean follow up was 21,5 months.</jats:p></jats:sec><jats:sec id="j_med-2019-0095_s_009_w2aab3b7d191b1b6b1aab1c15b4Aa"><jats:title>Conclusions</jats:title><jats:p>Our results prove PRAE to be a safe procedure with low complications rate. To our experience, PRAE seems to be a useful tool in surgical management of a large mass and advanced disease.</jats:p></jats:sec>

Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

“…Over the last two decades, arterial embolization has gained acceptance for several indications in the urological field, either as a minimally invasive alternative to surgery or as a complementary therapeutic tool to surgery [ 43 , 44 , 45 , 46 ]. Indeed, arterial embolization can be used as a first-line therapy for the treatment of bleedings following partial nephrectomy, as a prophylactic therapy for large renal angiomyolipomas, or as a preoperative tool before radical nephrectomy in order to facilitate surgical intervention by decreasing intraoperative bleeding [ 43 , 44 , 45 ]. It can also be used as a palliative treatment of hemorrhage from bladder or prostate cancer [ 46 ].…”

Metastatic renal Ewing’s sarcoma in adult woman: Case report and review of the literature

“…In literature, the real usefulness of preoperative renal embolization is still debated. However, a recent prospective, randomized study showed preoperative renal embolization to be a safe and well-tolerated procedure that allowed to reduce median blood loss in patients with huge kidney cancer who underwent embolization before nephrectomy compared to patients who did not undergo preoperative embolization [ 24 ].…”

Use of microspheres in embolization for unruptured renal angiomyolipomas

“…Thus, it is important to reduce the intraoperative blood loss. TAE has been recently reported useful for reduction of intraoperative blood loss for complex renal tumors [ 21 ]. It may also contribute to clear surgical margins [ 22 ].…”