The Value of Transvascular Embolization in the Treatment of Renal Carcinoma

Christensen, K. J. S.; Dyreborg, U; Andersen, J; Nissen, H. Melchior

doi:10.1016/s0022-5347(17)48877-x

Cited by 35 publications

(6 citation statements)

References 15 publications

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“…The same results were shown in more extensive tumors of stages T3/T4 as well as in tumors with a renal vein infiltration and regional lymph node metastases. In all the stages mentioned, we have been unable to demonstrate any statistically significant difference with regard to intraoperative blood loss and the duration of operation between the two groups, which is in concordance with other investigations (3,10,11). Only GIULIANI et coll.…”

Section: Discussionsupporting

confidence: 91%

Preoperative Renal Tumor Embolization

Fischedick¹,

Peters²,

Kleinhans³

et al. 1987

Acta Radiol

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The medical reports of 113 patients operated upon for renal tumors were retrospectively reviewed to assess the value of preoperative embolization. Coils or ethanol were used preoperatively in 55 patients while 58 patients underwent nephrectomy without embolization. The tumors were staged according to the TNM and the Robson staging classification. TI and T2 tumors as well as T3 and T4 tumors were grouped together for statistical evaluation. There was no significant difference in intraoperative blood loss, operation time and survival rate between patients undergoing preoperative embolization and those who had only nephrectomy. Duration of hospital stay was always longer in the preoperatively embolized group. Preoperative embolization of renal tumors neither improved the patients' outcome nor reduced the surgical risk. Robson's classification, stage III/IV, did not show any significant differences for embolized patients or for those nephrectomized without embolization.

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Section: Discussionsupporting

confidence: 91%

Preoperative Renal Tumor Embolization

Fischedick¹,

Peters²,

Kleinhans³

et al. 1987

Acta Radiol

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“…However, opinions on the role of preoperative RAE in the management of patients with RCC are controversial. Although a significant number of studies on RAE are reported in these patients, there is no consensus on the benefits and morbidity associated with the procedure [4–6]. Moreover, many large studies on the use of RAE were conducted in the 1980s, before the development of improved techniques and imaging.…”

Section: Introductionmentioning

confidence: 99%

Renal artery embolization: clinical indications and experience from over 100 cases

et al. 2006

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Renal artery embolization is used for various reasons, and authors from the USA review their experience of using this technique before nephrectomy in patients with large renal masses. They found it to be safe and effective, with minimal morbidity. They note the lack of published prospective randomized trials, and suspect that this contributes to it being underused. OBJECTIVE To review current indications and techniques for renal artery embolization (RAE) and more specifically to review cases of RAE before nephrectomy for treating patients with a large renal mass. PATIENTS AND METHODS All RAEs done at our institution between May 1993 and December 2005 were reviewed. Patients were identified using a database assembled by the Division of Cardiovascular Interventional Radiology. Indications, techniques and RAE‐related complications were then obtained from a retrospective review of medical records. Additional data for patients undergoing preoperative infarction were acquired, including estimated blood loss (EBL), transfusion requirement, pathological size, subtype, grade, stage, and level of tumour thrombus if present. RESULTS In all, there were 121 RAEs, 69 in males and 52 in females (mean age 57.6 years, range 11–89). Metallic microcoils were the most often used embolization agent, followed by acrylic microspheres (embospheres), polyvinyl alcohol particles, absolute ethanol, and Gelfoam (Pharmacia & Upjohn, USA). The most common indication for RAE was infarction before nephrectomy (54.5%). Other indications included symptomatic angiomyolipomas, palliation of unresectable renal cancer, haemorrhage, perinephric bleeding in end‐stage renal disease, vascular lesions, malignant hypertension, and sequelae of end‐stage renal disease. RAE‐associated complications including coil migration, incomplete embolization, and groin haematoma (in 5.0%). Symptoms of post‐infarction syndrome were common, with 74.4% of patients having flank pain, nausea, or vomiting; the vast majority of these symptoms were mild and self‐limited. In patients having nephrectomy after RAE the median (range) interval from RAE was 2 (0–78) days. The mean tumour size was 11.2 (3.5–25) cm and 46% of patients had tumour thrombus present in either the renal vein or inferior vena cava (IVC). The mean (median) overall EBL in patients having nephrectomy after RAE was 1048 (725) mL. The mean transfusion requirement over the course of hospitalization was 3.9 units of packed red blood cells. CONCLUSIONS RAE is a safe and effective therapeutic tool for many urological, renal and vascular conditions. Its use has increased at our institution due to improved techniques, embolization materials, and our increasing use of RAE as an adjuvant procedure for patients requiring nephrectomy with or without IVC thrombectomy. There are many potential operative advantages for patients having RAE before surgery, with minimal morbidity. It is likely that the lack of prospective randomized trials is the primary reason why it is underutilized in the preoperative setting.

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“…The technique of transcatheter embolization has been applied pre-operatively to both the primary tumor before nephrectomy [8,9] and metastatic bony lesions [10 Á13] to limit intra-operative blood loss. Selective transcatheter embolization of RCCa osseous metastases offers a reasonable and rational therapeutic approach for pain relief in this patient population.…”

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confidence: 99%