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938 Application of preoperative renal artery embolization in patients with renal cell carcinoma and venous tumor thrombus: An effective preoperative adjuvant therapy for patients with advanced tumor thrombus
938
Application of preoperative renal artery embolization in patients with renal cell carcinoma and venous tumor thrombus: An effective preoperative adjuvant therapy for patients with advanced tumor thrombus Eur Urol Suppl 2014;13;e938
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Tang Q.1 , Li X. 1 , Song Y. 1 , Wang J. 2 , He Z.1 , Zhou L. 1 1 Peking
University First Hospital, Dept. of Urology, Beijing, China, 2 Peking University First Hospital, Dept. of Cardiac Surgery, Beijing, China
INTRODUCTION & OBJECTIVES: To review our experience with preoperative renal artery embolization (RAE) in renal cell carcinoma (RCC) patients with venous extension and investigate its effect on perioperative outcomes and long-term prognosis. MATERIAL & METHODS: From Aug 2000 to Dec 2011, 140 RCC patients with venous tumor thrombus underwent radical nephrectomy and thrombectomy at our institute. The effect of embolization on perioperative outcomes and long-term survival were analyzed. RESULTS: Forty-six patients underwent preoperative RAE, and 94 patients did not. Patients in the embolization group tended to have a larger tumor (9.94 vs. 8.06 cm, P<0.001) and higher percentage of inferior vena cava tumor thrombus (56.5% vs. 36.2%, P=0.022). Compared to the non-embolization group, the embolization group had greater median blood loss (1000 vs. 475 ml, P=0.002) and longer operation time (4.5 vs. 3.5 hours, P=0.001). However, in the subgroup analysis of patients with advanced tumor thrombus (above the hepatic vein), preoperative RAE showed a significant benefit in reducing intraoperative blood loss (2000 vs. 5100 ml, P=0.043) and decreasing blood transfusion (1900 vs. 4425 ml, P=0.028). We did not find a measurable advantage in terms of long-term prognosis for patients in the embolization group, with a median survival of 43 months in the embolization group and 57 months in the non-embolization group (P=0.666). CONCLUSIONS: We did not find evidence that preoperative RAE should become a routine adjuvant procedure for RCC patients with venous tumor thrombus. However, we confirmed that preoperative RAE may be more appropriate for patients with advanced tumor thrombus because of its notable benefit in reducing intraoperative blood loss and blood transfusion. Prospective randomized trials are urgently needed to validate these findings.
Application of preoperative renal artery embolization in patients with renal cell carcinoma and venous tumor thrombus: An effective preoperative adjuvant therapy for patients with advanced tumor thrombus Eur Urol Suppl 2014;13;e938
Print! Print!
Tang Q.1 , Li X. 1 , Song Y. 1 , Wang J. 2 , He Z.1 , Zhou L. 1 1 Peking
University First Hospital, Dept. of Urology, Beijing, China, 2 Peking University First Hospital, Dept. of Cardiac Surgery, Beijing, China
INTRODUCTION & OBJECTIVES: To review our experience with preoperative renal artery embolization (RAE) in renal cell carcinoma (RCC) patients with venous extension and investigate its effect on perioperative outcomes and long-term prognosis. MATERIAL & METHODS: From Aug 2000 to Dec 2011, 140 RCC patients with venous tumor thrombus underwent radical nephrectomy and thrombectomy at our institute. The effect of embolization on perioperative outcomes and long-term survival were analyzed. RESULTS: Forty-six patients underwent preoperative RAE, and 94 patients did not. Patients in the embolization group tended to have a larger tumor (9.94 vs. 8.06 cm, P<0.001) and higher percentage of inferior vena cava tumor thrombus (56.5% vs. 36.2%, P=0.022). Compared to the non-embolization group, the embolization group had greater median blood loss (1000 vs. 475 ml, P=0.002) and longer operation time (4.5 vs. 3.5 hours, P=0.001). However, in the subgroup analysis of patients with advanced tumor thrombus (above the hepatic vein), preoperative RAE showed a significant benefit in reducing intraoperative blood loss (2000 vs. 5100 ml, P=0.043) and decreasing blood transfusion (1900 vs. 4425 ml, P=0.028). We did not find a measurable advantage in terms of long-term prognosis for patients in the embolization group, with a median survival of 43 months in the embolization group and 57 months in the non-embolization group (P=0.666). CONCLUSIONS: We did not find evidence that preoperative RAE should become a routine adjuvant procedure for RCC patients with venous tumor thrombus. However, we confirmed that preoperative RAE may be more appropriate for patients with advanced tumor thrombus because of its notable benefit in reducing intraoperative blood loss and blood transfusion. Prospective randomized trials are urgently needed to validate these findings.