| Objectives:Surgical treatment of renal cell carcinoma(RCC)patients with venous tumor thrombus,because the tumor blood supply is extremely rich,often bleeding more during the operation.There have been reports that preoperative renal artery embolization can be used to reduce intraoperative bleeding and operation time in these patients.This article will explore the clinical significance of instant renal artery embolism(I-RAE)before nephrectomy and tumor thrombectomy for these patients.Methods:We performed a retrospective analysis of 54 patients admitted to Department of urology,Shandong provincial Hospital Affiliated to Shandong University treated with nephrectomy and thrombectomy between Jan 2012 and Jan 2019.Twenty-four patients were treated by I-RAE before surgery.Thirty patients were performed surgery alone.The patient demographics,operation time,blood loss,transfusion requirements,complications and other surgical parameters were analyzed between the two groups.In terms of the prognosis of patients,univariate analysis showed that patients with intraoperative hemorrhage of>500ml and tumor volume of>7cm had poor prognosis.Results:A total of 54 patients were included in this study.There were no statistical differences in the general characteristics(gender,age,BMI,tumor side,clinical stage,tumor thrombus grade,cardiac function,and anesthesia grade)between the embolization group and the non-embolization group.The average blood loss in the embolization group was significantly lower than that in the non-embolization group(596 ± 321ml vs 827 ± 347ml,P=0.015),the possibility of blood transfusion was greater in the non-embolization group(RBC,4U vs 6U,p=0.026;Plasma capacity,200ml versus 400ml,p=0.018).The mean maximum diameter of tumors in the embolization group was significantly greater than that in the non-embolization group(11.0±3.5cm vs 8.0±2.7cm,p=0.001).According to the MAYO Clinic tumor thrombectomy grading system,54 patients were graded on the level of venous thrombectomy,The embolization group was compared with the non-embolization group:level 0 has 14 cases(6 v 8),grade ? has 16 cases(9 vs 7),grade ? has 15 cases(6 vs 9),grade ? has 6 cases(2 vs 4),and grade IV has 3 patients(1 vs 2)p=0.83).There were no statistically significant differences between the two groups in surgical methods,operation time,ICU care time,postoperative hospitalization time,postoperative drainage tube withdrawal time,perioperative complications,postoperative pathological results and pathological grades.In terms of the prognosis of the patients,through univariate analysis,the RFS and OS of patients with intraoperative bleeding>500ml and patients with tumor volume>7cm are shorter and the prognosis is worse.Multivariate analysis of the Cox model showed that intraoperative bleeding>500ml and the largest diameter of the tumor were independent risk factors that affected RFS and OS in these patients.Conclusion:The adjuvant instant pre-operative renal artery embolization(I-RAE)is a safe technique.It facilitates the nephrectomy and thrombectomy by reduction of blood loss,transfusion requirements and complication of delayed operation,providing the urologists with a reliable option for locally advanced RCC with tumor thrombus.Research significance:Foreign research on renal artery embolization is often performed after 24 hours.Domestic reports have also reported the role of renal artery embolization before radical operation of renal cancer,but it is often carried out 3-15 days after embolization.This article reports the effect of preoperative renal artery embolization(within 3 hours of embolization)on patients with renal cell carcinoma and venous thrombosis in recent years,and for the first time proposed the concept of immediate renal artery embolization. |
PDF Full Text Request