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

ANZ J Surg. 2014 Jul-Aug;84(7-8):564-7. doi: 10.1111/ans.12545. Epub 2014 Feb 18.

Abstract

Background: To assess the outcomes of patients undergoing percutaneous renal artery embolization (PRAE) prior to radical nephrectomy.

Methods: We performed retrospective chart review of patients undergoing PRAE in Auckland Public Hospital from January 2004 to December 2011. PRAE was performed under epidural anaesthesia and within 24 h of nephrectomy. We compared our perioperative outcomes with the published literature.

Results: Forty-two patients were identified in this series. Patients had predominantly more advanced stage disease with 30 (71%) being T3 or higher (TNM staging). Median operation time was 192 min (range 84-428). 45.2% of patients experienced complications from the surgery. There were no complications associated with PRAE.

Conclusions: PRAE prior to nephrectomy is a safe procedure. There is no convincing evidence in the literature that the benefits outweigh the risks. All published studies are non-randomized and subject to selection bias, so the true role of PRAE has not yet been determined and routine use is probably not justified.

Keywords: IVC thrombus; nephrectomy; renal artery embolization.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Renal Cell / mortality
  • Carcinoma, Renal Cell / pathology
  • Carcinoma, Renal Cell / therapy*
  • Embolization, Therapeutic*
  • Female
  • Humans
  • Kidney Neoplasms / mortality
  • Kidney Neoplasms / pathology
  • Kidney Neoplasms / therapy*
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Nephrectomy*
  • Operative Time
  • Renal Artery*
  • Retrospective Studies
  • Treatment Outcome