Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases

Abstract Background: The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in locally advanced renal cell carcinoma patients with venous thrombus.Methods: We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between Jan 2012 and Jan 2019. Twenty-four patients were treated by I-RAE before surgery. Thirty patients were performed surgery alone (Non-RAE). The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed between the two groups.Results: The mean tumor size in I-RAE group was significantly larger than that in the Non-RAE group (11.1cm versus 7.9cm; p = .001). The mean estimated blood loss was significantly lower in I-RAE group compared to Non-RAE group (596ml versus 827ml; p = .015), and the patients in the Non-RAE group were more likely to receive blood transfusion (RBC units, 4U versus 6U, p = .025; plasma volume, 200ml versus 400ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications and length of postoperative hospitalization. Conclusions: The adjuvant instant pre-operative renal artery embolization (I-RAE) is a safe technique. It facilitates the nephrectomy and thrombectomy by reduction of blood loss, transfusion requirements and complication of delayed operation, providing the urologists with a reliable option for locally advanced RCC with tumor thrombus.

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Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: A retrospective study of 54 cases

10.21203/rs.3.rs-28801/v2 ◽

2020 ◽

Author(s):

Guangxin Tang ◽

xiaoxu chen ◽

Jianwei Wang ◽

Wei He ◽

Zhihong Niu

Keyword(s):

Blood Loss ◽

Renal Artery ◽

Locally Advanced ◽

Operation Time ◽

Artery Embolization ◽

Venous Thrombus ◽

Estimated Blood Loss ◽

Transfusion Requirements ◽

Renal Artery Embolization ◽

The Mean

Abstract Background: The role of renal artery embolization (RAE) in the therapeutic armamentarium is always controversial. The present study aimed to assess the safety and the surgical outcomes of the instant renal artery embolization (I-RAE) prior to nephrectomy and thrombectomy in patients with locally advanced renal cell carcinoma (RCC) with venous thrombus.Methods: We performed a retrospective analysis of 54 patients treated with nephrectomy and thrombectomy between January 2012 and January 2019. Twenty-four patients were treated with I-RAE before surgery. Thirty patients received surgery alone (non-RAE group). The patient demographics, operation time, blood loss, transfusion requirements, complications and other surgical parameters were analyzed between the two groups.Results: The mean tumor size in the I-RAE group was significantly larger than that in the non-RAE group (11.1 cm versus 7.9 cm; p = .001). The mean estimated blood loss was significantly lower in the I-RAE group compared to that in the non-RAE group (596 ml versus 827 ml; p = .015), and the patients in the Non-RAE group were more likely to receive blood transfusion (red blood cell, RBC units, 4 U versus 6 U, p = .025; plasma volume, 200 ml versus 400 ml, p = .01). No differences were found in operative duration, ICU stay, perioperative complications and length of postoperative hospitalization. Conclusions: Instant preoperative adjuvant renal artery embolization (I-RAE) is a safe technique. It facilitates nephrectomy and thrombectomy by reducing blood loss, transfusion requirements and complications of delayed operations, providing urologists with a reliable option for treatment of locally advanced RCC with tumor thrombus.

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Renal artery embolization immediately before laparoscopic radical nephrectomy for T3 renal cancer

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2012.06.387 ◽

2012 ◽

Vol 215 (3) ◽

pp. S150

Author(s):

Kelly C. Johnson ◽

Adam Howe ◽

Saum Rahimi ◽

Robert E. Weiss ◽

Murali K. Ankem

Keyword(s):

Renal Artery ◽

Renal Cancer ◽

Radical Nephrectomy ◽

Artery Embolization ◽

Laparoscopic Radical Nephrectomy ◽

Renal Artery Embolization

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Potential benefit of renal artery embolization on oncological outcomes in a contemporary cohort of patients with locally advanced renal cell carcinoma

European Urology Open Science ◽

10.1016/s2666-1683(21)00950-2 ◽

2021 ◽

Vol 32 ◽

pp. S127

Author(s):

V. Cellini ◽

J.A. Rossi de Vermandois ◽

G. Manfredini ◽

G. Maiolino ◽

G. Felici ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Renal Artery ◽

Cell Carcinoma ◽

Renal Cell ◽

Potential Benefit ◽

Locally Advanced ◽

Advanced Renal Cell Carcinoma ◽

Artery Embolization ◽

Oncological Outcomes ◽

Renal Artery Embolization

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Renal artery embolization before radical nephrectomy for complex renal tumor: Which are the true advantages?

European Urology Supplements ◽

10.1016/s1569-9056(19)33530-4 ◽

2019 ◽

Vol 18 (9) ◽

pp. e3187

Author(s):

M. Del Zingaro ◽

G. Cochetti ◽

E. Lepri ◽

G. Gaudio ◽

I. Soli ◽

...

Keyword(s):

Renal Artery ◽

Radical Nephrectomy ◽

Renal Tumor ◽

Artery Embolization ◽

Renal Artery Embolization

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

Open Medicine ◽

10.1515/med-2019-0095 ◽

2019 ◽

Vol 14 (1) ◽

pp. 797-804 ◽

Cited By ~ 2

Author(s):

Giovanni Cochetti ◽

Michele Del Zingaro ◽

Andrea Boni ◽

Massimiliano Allegritti ◽

Jacopo Adolfo Rossi de Vermandois ◽

...

Keyword(s):

Blood Loss ◽

Renal Artery ◽

Radical Nephrectomy ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Safe Procedure ◽

Artery Embolization ◽

Renal Masses ◽

Major Complications ◽

Renal Artery Embolization

AbstractIntroductionRenal 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.Materials and methodsFrom 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.ResultsMedian 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.ConclusionsOur 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.

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