ROLE OF PRE-OPERATIVE SELECTIVE ARTERIAL EMBOLIZATION OF RENAL TUMORS IN NEPHRON-SPARING SURGERY: A PILOT STUDY.

Document Type : Original Article

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Department of Urology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

Abstract

Background: Partial nephrectomy (PN) has emerged as a greatly underutilized procedure that is often feasible given adequate surgeon expertise. No consensus on the use of renal artery embolization (RAE) has been fashioned due to the small number of prospective studies comparing surgical resection combined with preoperative embolization versus surgery alone. Aim of the Work: to evaluate the beneficial role of preoperative selective arterial embolization of renal tumors amenable for nephron-sparing surgery (NSS) in enhancing intra-operative challenging difficulties such as: decreasing blood loss and transfusion requirements, decreasing operative time, facilitating tumor dissection and replacing ischemic techniques. Patients and Methods: Overall, a total of 20 patients with renal masses amenable for nephron-sparing surgery were included in our study. PN after selective pre-operative RAE of the tumor feeding vessels were performed for all patients without renal ischemia. Perioperative data as operative time, blood loss and transfusion requirements were recorded, correlated and statistically analyzed. Results: In all patients, 2 had significant intra-operative blood loss and required blood transfusion. Patients demographics didn’t affect the results. Tumor data had no significant statistical effect on the results. The most important parameter was whether embolization was complete or incomplete. Conclusion: Benefits of RAE in the preoperative setting include a decrease in operative time and blood loss and creation of a tissue
plane of edema facilitating dissection. To date, RAE has not been evaluated in a randomized controlled setting which has contributed to its underutilization

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