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 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.

Effective strategies to enhance the diagnosis and treatment of RCC: The application of biocompatible materials

“…Hydrogels are recognized for their distinctive importance and utility as drug delivery systems. Transarterial embolization of has been established as an efficacious method for expanding surgical options for RCC [ 106 ]. The significance of transarterial chemoembolization (TACE) in the palliative treatment of patients with malignant tumors is acknowledged [ 107 ].…”

A Narrative Review on Robotic Surgery as Treatment for Renal Cell Carcinoma with Inferior Vena Cava Thrombus

“…During the nephrectomy, these patients had less estimated blood loss and transfusion requirements. However, there was no difference in the duration of operation, intensive care unit stay, hospital length of stay, or perioperative complications [ 57 ]. Another retrospective study found that patients with preoperative RAE had a 5-year survival rate of 62% and a 10-year survival rate of 47%, which was significantly higher than 35% and 23%, respectively, in the case-matched control group without RAE.…”

Survival Benefits After Surgery of Renal Cell Carcinoma Patients with Inferior Vena Cava Thrombus

“…Previous study from Cleveland Clinic demonstrated signi cant risk of perioperative mortality in patients with preoperative embolization (OR 5.5, p=0.03) as well as postoperative complications 13 . Recent study from Tang and colleagues, however, supported reduced blood loss and transfusion in patients receiving perioperative embolization(p<0.03) 14 . Notably, patients from Cleveland Clinic cohort had higher thrombus level when compared to Tang's study.…”