Preoperative embolization of bone metastases from renal cell carcinoma

Abstract

The purpose of this study was to correlate the effectiveness of preoperative embolization with the blood loss and transfusion requirement during surgery for bone metastases from renal cell carcinoma. Twenty-eight preoperative embolizations in 26 patients with renal cell carcinoma metastatic to bone were retrospectively evaluated and divided into two groups: Group A included the embolizations that resulted in complete devascularization of the lesion as defined by the post-embolization arteriograms, and group B included those with an incomplete result. The two groups were compared with regard to blood loss and transfusion requirement during surgery, by unpaired two-tailed Student's t-test. Where complete embolization was effected (group A, 10 cases), there was a mean blood loss of 535 +/- 390 ml. When a less than complete embolization was achieved (group B, 18 cases), the mean blood loss was 1.247 +/- 1.047 ml (p = 0.049). The red blood cell transfusion in group A was 1.3 +/- 1 units, whereas in group B it was 2.4 +/- 1.2 (p = 0.03). Preoperative embolization of bone metastases from renal cell carcinoma with subsequent complete devascularization leads to significant reduction of blood loss during surgery. Interventional radiologists should pursue and embolize every feeder to the metastasis, because any less than complete devascularization increases the amount of blood loss and the amount of red blood cell transfusion during surgery.

Embolization of Hypervascular Bone Metastases Reduces Intraoperative Blood Loss: A Case-control Study

“…No agreement exists on the effect of degree of devascularization on estimated blood loss. Some authors suggest that tumor devascularization reduces estimated blood loss [2,4,6,16]; however, some have found no correlation between tumor devascularization and estimated blood loss [7]. In our study, we found no correlation between degree of devascularization and estimated blood loss.…”

Preoperative embolization of primary bone tumors: A case control study

“…In contrast, as reported by the previous studies where TAE was performed, spinal column was the most common sites and most of these tumors were metas tatic in nature than primary bone tumor [15,16,19,22,28,29] . Retrospective study done by Radeleff et al [17] studied four metastatic lower limb tumors and five metastatic upper limb tumors out of 31 patients.…”

“…Similarly 23 patients (82%) of our control group had GCT. None of the previous studies from literature comprised of this number of GCT and the most common histology in previous studies was metastatic tumors [16,19,21,22] . In a prospective study done by Lee et al [13] total 6 patients were studied.…”

“…The embolisation endpoint was decided to be when all major vessels supplying the tumor were embolised and there was essentially near complete obliteration of tumor blush ( Figure 1). Percentage of reduction of tumor blush was categorized into three groups as mentioned in previous studies, < 50% reduction, 50%75% reduction and > 75% reduction [16,24] . More than > 75% reduction of tumor blush was achieved in 24 patients (92%), and 50%75% in 2 patients (8%).…”

Preoperative Embolisation in Benign Bone Tumour Excision

“…Embolisation is useful in (1) treatment of vertebral haemangiomas, 1 (2) palliative treatment of bone pain in metastases, 2 (3) reduction of intra-operative blood loss in bone metastases from renal cell carcinoma, 3,4 and (4) treatment of vertebral metastases. 5,6 Preoperative embolisation of benign lesions in the spine and sacrum is reported to reduce blood loss, aid surgery, and act as a primary treatment modality.…”