The Significance of Transvascular Embolization in Radical Nephrectomy

Abstract

To evaluate the significance of preoperative transvascular embolization in the radical nephrectomy, thirty-seven patients with renal cell carcinoma underwent transvascular embolization followed by radical nephrectomy one day after. Thirty-five cases became available for clinicopathological examination with reference to the perioperative blood loss, duration of operation and prognosis, comparing to those of twelve cases with nephrectomy alone.The degree of renal infarct induced by embolization was divided into four groups by the extent of cortical necrosis sparing the subcapsular areas, which was the histologic characteristic about 24 hours after the embolization.Among 35 cases with embolization, 18 cases (51. 4%) were grouped into Grade N, 10 cases (28. 6%) into Grade 111, 3 cases (8. 6%) into Grade II and 4 cases (11. 4%) into Grade I. Thus, it was proved that the renal infarct induced by embolization was various in extent about 24 hours after the embolization. And comparing the grade of renal infarct with the degree of radiological occlusion by viewing the progress of contrast medium, there was no definite mutual relation between them. Also, there was no mutual relation between the kind of embolant and the grade of renal infarct.Although embolization could make less significant decrease in the blood loss and duration of the operation, the blood loss of the Grade N group in embolization was proved to be least.The survival rate after embolization and nephrectomy was better than after nephrectomy alone, in particular, the survival rate of Grade N group was excellent.Our study demonstrated that it was important for getting better perioperative effect and prognosis to occlude the renal arterial flow completely by embolization, resulting in prohibiting the release of tumor cells from the primary site and the metastasis.