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524 Preoperative renal artery embolization in renal carcinoma with venous thrombus: Preliminary results of a multicenter study
524
Preoperative renal artery embolization in renal carcinoma with venous thrombus: Preliminary results of a multicenter study Eur Urol Suppl 2016;15(3);e524
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Vazquez-Martul Pazos D.1 , Chantada V.C. 1 , Capitanio U.2 , Carballido J.A.3 , Chromecki T.4 , Ciancio G.5 , Daneshmand S. 6 , Evans C.P. 7 , Gontero P. 8 , González J. 9 , Haferkamp A. 10 , Hohenfellner M. 11 , Huang W.C.12 , Koppie T.M.13 , Linares Espinós E. 14 , Lorentz A. 15 , Martínez-Salamanca J.I. 3 , Mass A.Y.12 , Master V.A.15 , McKiernan J.M.16 , Montorsi F.2 , O'Malley P. 17 , Pahernik S. 11 , Palou J. 18 , Pontones Moreno J.L. 19 , Pruthi R.S. 20 , Rodriguez Faba O.18 , Russo P. 21 , Scherr D.S. 17 , Shariat S.F. 22 , Spahn M. 23 , Terrone C.24 , Tilki D.7 , Vera Donoso C.D.19 , Vergho D.23 , Wallen E.M.20 , Zigeuner R.4 , Libertino J.A.25 , International Renal Cell Carcinoma-Venous Thrombus Consortium 1 Complejo
Hospitalario Universitario A Coruña, Dept. of Urology, A Coruña, Spain, 2 Hospital San Raffaele, University Vita-Salute, Dept. of
Urology, Milan, Italy, 3 Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Dept. of Urology, Madrid, Spain, 4 Medical University of Graz, Dept. of Urology, Graz, Austria, 5 Miami Transplant Institute, University of Miami, Dept. of Urology, Miami, United States of America, 6 USC/Norris Comprehensive Cancer Center, Dept. of Urology, Los Angeles, United States of America, 7 UC
Davis Medical Center, Dept. of Urology, Sacramento, United States of America, 8 A.O.U. San Giovanni Battista, University of Turin,
Dept. of Urology, Turin, Italy, 9 Hospital Central de la Cruz Roja San José y Santa Adela, Dept. of Urology, Madrid, Spain, 10 University of Frankfurt, Dept. of Urology, Frankfurt, Germany, 11 University of Heidelberg, Dept. of Urology, Heidelberg, Germany, 12 New York University School of Medicine, Dept. of Urology, New York, United States of America, 13 Oregon Health & Science University, Dept. of Urology, Portland, United States of America, 14 Hospital Universitario Infanta Sofía, Dept. of Urology, Madrid, Spain, 15 Emory University, Dept. of Urology, Atlanta, United States of America, 16 Columbia University College of Physicians and Surgeons, Dept. of Urology, New York, United States of America, 17 Weill Cornell Medical Center, Dept. of Urology, New York, United States of America, 18 Fundació Puigvert, Dept. of Urology, Barcelona, Spain, 19 Hospital Universitario y Politécnico La Fe, Dept. of Urology, Valencia, Spain, 20 UNC at Chapel Hill, Dept. of Urology, Chapel Hill, United States of America, 21 Memorial Sloan Kettering Cancer Center, Dept. of Surgery, Urology Service, New York, United States of America, 22 Medical University of Vienna, Dept. of Urology, Vienna, Austria, 23 University of Würzburg, Dept. of Urology, Würzburg, Germany, 24 Maggiore della Carita Hospital, University of Eastern Piedmont, Division of Urology, Novara, Italy, 25 Lahey Clinic, Dept. of Urology, Burlington, United States of America INTRODUCTION & OBJECTIVES: The presence of venous tumour thrombus (VTT) in advanced renal cell carcinoma (RCC) makes clinical and surgical management challenging. Preoperative embolization has been used as a complementary intervention to facilitate surgical resection of complex renal tumours. Our objective is to analyse surgical and clinical outcomes in those patients with renal artery embolization (RAE) previous to oncological surgery. MATERIAL & METHODS: A total of 1380 patients with diagnosis of RCC with VTT from 1972 to 2014 from 22 Centers in the United States and Europe were retrospectively analysed. We compare those patients undergoing surgery with or without previous RAE. A univariable analysis was performed for surgery time, intraoperative bleeding, number of blood units transfused, length of hospital stay and presence of complications. RESULTS: 256 patients out of 1380 underwent RAE prior to radical nephrectomy and tumour trombectomy.
Both groups characteristics are described in table 1:
Sex male female Age ECOG (mean) ASA (mean) Karnofsky (mean) Charson (mean) Side Right Left Bilateral Size (mean) Synchronous Metastasis M0 M1 Mx Thrombus level (Mayo) I-II III-IV
No RAE 766(68.1) 358(31.9) 61.9 0.81 2.68 82.17 4.1 742(66.1) 370(32.9) 11(1) 9.52 541(49) 296(26.8) 268(24.3) 711(63.3) 413(36.8)
RAE 157(61.3) 99(38.7) 61.7 0.92 3 82.21 3.5 174(68) 81(31.6) 1(0.4) 10.53 140(57.6) 63(25.9) 40(16.5) 144(56.2) 112(43.8)
Outcomes are summarized in table 2:
Operating time (minutes) No RAE RAE Intraop. Bleeding (cc) No RAE RAE Intraoperative Blood Units No RAE RAE Hospital stay (days) No RAE RAE
Mean 303.63 385.21 2533.5 2716.1 6.05 8.11 14.4 19.8
Median 269.5 365 1200 1600 3 5 11 16
p-value <0.001 =0.633 <0.001 <0.001
The presence of any kind of complication were 119 (70.8%) for RAE compared with 546 (58.6%) for patients wihout RAE, p=0.003. CONCLUSIONS: A longer hospital stay with a higher intraoperative bleeding, need of blood transfusion and presence of surgical complications are seen on preoperative RAE patients. Further analysis are needed to finally confirm this data.
Preoperative renal artery embolization in renal carcinoma with venous thrombus: Preliminary results of a multicenter study Eur Urol Suppl 2016;15(3);e524
Print! Print!
Vazquez-Martul Pazos D.1 , Chantada V.C. 1 , Capitanio U.2 , Carballido J.A.3 , Chromecki T.4 , Ciancio G.5 , Daneshmand S. 6 , Evans C.P. 7 , Gontero P. 8 , González J. 9 , Haferkamp A. 10 , Hohenfellner M. 11 , Huang W.C.12 , Koppie T.M.13 , Linares Espinós E. 14 , Lorentz A. 15 , Martínez-Salamanca J.I. 3 , Mass A.Y.12 , Master V.A.15 , McKiernan J.M.16 , Montorsi F.2 , O'Malley P. 17 , Pahernik S. 11 , Palou J. 18 , Pontones Moreno J.L. 19 , Pruthi R.S. 20 , Rodriguez Faba O.18 , Russo P. 21 , Scherr D.S. 17 , Shariat S.F. 22 , Spahn M. 23 , Terrone C.24 , Tilki D.7 , Vera Donoso C.D.19 , Vergho D.23 , Wallen E.M.20 , Zigeuner R.4 , Libertino J.A.25 , International Renal Cell Carcinoma-Venous Thrombus Consortium 1 Complejo
Hospitalario Universitario A Coruña, Dept. of Urology, A Coruña, Spain, 2 Hospital San Raffaele, University Vita-Salute, Dept. of
Urology, Milan, Italy, 3 Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid, Dept. of Urology, Madrid, Spain, 4 Medical University of Graz, Dept. of Urology, Graz, Austria, 5 Miami Transplant Institute, University of Miami, Dept. of Urology, Miami, United States of America, 6 USC/Norris Comprehensive Cancer Center, Dept. of Urology, Los Angeles, United States of America, 7 UC
Davis Medical Center, Dept. of Urology, Sacramento, United States of America, 8 A.O.U. San Giovanni Battista, University of Turin,
Dept. of Urology, Turin, Italy, 9 Hospital Central de la Cruz Roja San José y Santa Adela, Dept. of Urology, Madrid, Spain, 10 University of Frankfurt, Dept. of Urology, Frankfurt, Germany, 11 University of Heidelberg, Dept. of Urology, Heidelberg, Germany, 12 New York University School of Medicine, Dept. of Urology, New York, United States of America, 13 Oregon Health & Science University, Dept. of Urology, Portland, United States of America, 14 Hospital Universitario Infanta Sofía, Dept. of Urology, Madrid, Spain, 15 Emory University, Dept. of Urology, Atlanta, United States of America, 16 Columbia University College of Physicians and Surgeons, Dept. of Urology, New York, United States of America, 17 Weill Cornell Medical Center, Dept. of Urology, New York, United States of America, 18 Fundació Puigvert, Dept. of Urology, Barcelona, Spain, 19 Hospital Universitario y Politécnico La Fe, Dept. of Urology, Valencia, Spain, 20 UNC at Chapel Hill, Dept. of Urology, Chapel Hill, United States of America, 21 Memorial Sloan Kettering Cancer Center, Dept. of Surgery, Urology Service, New York, United States of America, 22 Medical University of Vienna, Dept. of Urology, Vienna, Austria, 23 University of Würzburg, Dept. of Urology, Würzburg, Germany, 24 Maggiore della Carita Hospital, University of Eastern Piedmont, Division of Urology, Novara, Italy, 25 Lahey Clinic, Dept. of Urology, Burlington, United States of America INTRODUCTION & OBJECTIVES: The presence of venous tumour thrombus (VTT) in advanced renal cell carcinoma (RCC) makes clinical and surgical management challenging. Preoperative embolization has been used as a complementary intervention to facilitate surgical resection of complex renal tumours. Our objective is to analyse surgical and clinical outcomes in those patients with renal artery embolization (RAE) previous to oncological surgery. MATERIAL & METHODS: A total of 1380 patients with diagnosis of RCC with VTT from 1972 to 2014 from 22 Centers in the United States and Europe were retrospectively analysed. We compare those patients undergoing surgery with or without previous RAE. A univariable analysis was performed for surgery time, intraoperative bleeding, number of blood units transfused, length of hospital stay and presence of complications. RESULTS: 256 patients out of 1380 underwent RAE prior to radical nephrectomy and tumour trombectomy.
Both groups characteristics are described in table 1:
Sex male female Age ECOG (mean) ASA (mean) Karnofsky (mean) Charson (mean) Side Right Left Bilateral Size (mean) Synchronous Metastasis M0 M1 Mx Thrombus level (Mayo) I-II III-IV
No RAE 766(68.1) 358(31.9) 61.9 0.81 2.68 82.17 4.1 742(66.1) 370(32.9) 11(1) 9.52 541(49) 296(26.8) 268(24.3) 711(63.3) 413(36.8)
RAE 157(61.3) 99(38.7) 61.7 0.92 3 82.21 3.5 174(68) 81(31.6) 1(0.4) 10.53 140(57.6) 63(25.9) 40(16.5) 144(56.2) 112(43.8)
Outcomes are summarized in table 2:
Operating time (minutes) No RAE RAE Intraop. Bleeding (cc) No RAE RAE Intraoperative Blood Units No RAE RAE Hospital stay (days) No RAE RAE
Mean 303.63 385.21 2533.5 2716.1 6.05 8.11 14.4 19.8
Median 269.5 365 1200 1600 3 5 11 16
p-value <0.001 =0.633 <0.001 <0.001
The presence of any kind of complication were 119 (70.8%) for RAE compared with 546 (58.6%) for patients wihout RAE, p=0.003. CONCLUSIONS: A longer hospital stay with a higher intraoperative bleeding, need of blood transfusion and presence of surgical complications are seen on preoperative RAE patients. Further analysis are needed to finally confirm this data.