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

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 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.

scholarly journals 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

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.

scholarly journals Treatment of irreducible atlantoaxial dislocation using one-stage retropharyngeal release and posterior reduction

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901987046 ◽  
Author(s):  
Xianfeng Ren ◽  
Feng Gao ◽  
Siyuan Li ◽  
Jiankun Yang ◽  
Yongming Xi
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Atlantoaxial Dislocation ◽  
Efficacy And Safety ◽  
Estimated Blood Loss ◽  
Irreducible Atlantoaxial Dislocation ◽  
The Mean

Introduction: Irreducible atlantoaxial dislocation (IAAD) has been challenging for spine surgeons. Various methods have been used to treat IAAD, but no consensus has been reached. This study aimed to retrospectively analyze the efficacy of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. Methods: From March 2007 to May 2015, 13 patients diagnosed with IAAD underwent anterior submandibular retropharyngeal release and sequential posterior reduction and fixation. The operation time, blood loss, postoperative complications, and Japanese Orthopaedic Association (JOA) scores were retrospectively recorded. Results: The surgeries were accomplished successfully. The mean operative time was about 3.8 h. The mean estimated blood loss was about 130 mL. The patients experienced postoperative pharyngeal pain. Only one patient had a vague voice and increased oral discharge postoperatively. At the final follow-up, JOA scores had significantly increased ( p < 0.05), and all the patients had solid bony fusion. Conclusion: The present study reinforces the efficacy and safety of anterior submandibular retropharyngeal release and posterior reduction and fixation for IAAD. It can achieve satisfactory clinical outcomes and is safe for experienced spine surgeons.

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

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 797-804 ◽  
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.

Anesthetic management of radical nephrectomy in patients with renal cell carcinoma involving renal vein or inferior vena cava

2019 ◽  
Vol 105 (5) ◽  
pp. 411-416
Author(s):  
Kun Chen ◽  
Juan Wang ◽  
Jinzhen Dai ◽  
Ailin Luo ◽  
Yuke Tian ◽  
...  
Keyword(s):  
Blood Loss ◽  
Renal Vein ◽  
Radical Nephrectomy ◽  
Inferior Vena ◽  
Anesthetic Management ◽  
Vena Cava ◽  
Operation Time ◽  
Level Ii ◽  
Estimated Blood Loss ◽  
The Mean

Objective: To investigate the perioperative anesthetic management of patients diagnosed with renal cell carcinoma (RCC) metastasized into the renal vein or inferior vena cava (IVC) after undergoing radical nephrectomy to provide clinical evidence for rational anesthetic interventions. Methods: A total of 81 patients with RCC extending into the renal vein or IVC, aged 17–73 years, undergoing radical nephrectomy were recruited. Preoperative status, intraoperative management, average operation time, average estimated blood loss, postanesthesia outcomes, and postoperative complications were retrospectively analyzed. Results: The mean operation time was 288 minutes (range 146–825 minutes). The mean estimated blood loss was recorded as 1905 mL (range 200–7000 mL). Among 81 cases, 9 patients (11.1%, 1 level II, 3 level III, and 5 level IV) were switched to undergo cardiopulmonary bypass. Significant hemodynamic fluctuations were observed in 39 patients who presented with level II–IV of tumor thrombus. One patient had pulmonary embolism and died of active cardiopulmonary resuscitation. The mean postoperative hospital stay was 12.8 days. Twenty-five cases with level III–IV tumor thrombus were transferred to the intensive care unit with endotracheal intubation due to massive intraoperative blood loss. The remaining 55 cases were transferred to the postanesthesia care unit 2 hours before being transferred to the ward. One patient had postoperative acute coronary syndrome and was discharged after effective interventions. Conclusion: Anesthetic management and intensive postoperative care play a pivotal role in the success of complete resection of RCC that metastasize into the IVC.

Renal artery embolization prior to nephrectomy for locally advanced renal cell carcinoma

2014 ◽  
Vol 84 (7-8) ◽  
pp. 564-567 ◽  
Author(s):  
Homayoun Zargar ◽  
Ben Addison ◽  
John McCall ◽  
Adam Bartlett ◽  
Brendan Buckley ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Renal Artery ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Locally Advanced ◽  
Advanced Renal Cell Carcinoma ◽  
Artery Embolization ◽  
Renal Artery Embolization

scholarly journals Feasibility of Endoscopy-Assisted Laparoscopic Full-Thickness Resection for Superficial Duodenal Neoplasms

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Ken Ohata ◽  
Masahiko Murakami ◽  
Kimiyasu Yamazaki ◽  
Kouichi Nonaka ◽  
Nobutsugu Misumi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Operation Time ◽  
Full Thickness ◽  
Duodenal Neoplasms ◽  
Invasive Treatment ◽  
En Bloc ◽  
Estimated Blood Loss ◽  
Delayed Perforation ◽  
The Mean

Background. Superficial duodenal neoplasms (SDNs) are a challenging target in the digestive tract. Surgical resection is invasive, and it is difficult to determine the site and extent of the lesion from outside the intestine and resect it locally. Endoscopic submucosal dissection (ESD) has scarcely been utilized in the treatment of duodenal tumors because of technical difficulties and possible delayed perforation due to the action of digestive juices. Thus, no standard treatments for SDNs have been established. To challenge this issue, we elaborated endoscopy-assisted laparoscopic full-thickness resection (EALFTR) and analyzed its feasibility and safety.Methods. Twenty-four SDNs in 22 consecutive patients treated by EALFTR between January 2011 and July 2012 were analyzed retrospectively.Results. All lesions were removed en bloc. The lateral and vertical margins of the specimens were negative for tumor cells in all cases. The mean sizes of the resected specimens and lesions were 28.9 mm (SD ± 10.5) and 13.3 mm (SD ± 11.6), respectively. The mean operation time and intraoperative estimated blood loss were 133 min (SD ± 45.2) and 16 ml (SD ± 21.1), respectively. Anastomotic leakage occurred in three patients (13.6%) postoperatively, but all were minor leakage and recovered conservatively. Anastomotic stenosis or bleeding did not occur.Conclusions. EALFTR can be a safe and minimally invasive treatment option for SDNs. However, the number of cases in this study was small, and further accumulations of cases and investigation are necessary.

scholarly journals Hepatic Resection Using a Water Jet Dissector

HPB Surgery ◽  
1993 ◽  
Vol 6 (3) ◽  
pp. 189-198 ◽  
Author(s):  
H. U. Baer ◽  
S. C. Stain ◽  
T. Guastella ◽  
G. J. Maddern ◽  
L. H. Blumgart
Keyword(s):  
Blood Loss ◽  
Hepatic Resection ◽  
Water Jet ◽  
Parenchymal Transection ◽  
Fracture Group ◽  
Mortality And Morbidity ◽  
Operative Duration ◽  
Estimated Blood Loss ◽  
Transfusion Requirements ◽  
The Mean

The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure, high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished.

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