Laparoscopic partial nephrectomy: the effect of preoperative tumor embolization

The purpose of this study was to describe our initial experience with preoperative tumor embolization for laparoscopic partial nephrectomy. Between September 2003 and August 2004, six patients with solid hypervascular renal tumors were treated with a combination of preoperative tumor embolization and laparoscopic partial nephrectomy. Ethanol (100%) was used to preoperatively embolize all major vessels supplying the tumor. The laparoscopic partial nephrectomy procedure was performed without clamping the renal vessels. The mean tumor size was 2.9 cm (range, 2.0-4.0 cm). Mean estimated blood loss was 177mL (range, 40-410 mL). Mean laparoscopy time was 243 minutes (range, 160-290 minutes). Histopathology demonstrated an infected cyst in one patient and a pT1 renal cell carcinoma in five patients, including a specimen with a positive tumor margin. After a mean follow-up period of 30 months (range, 25-36 months), neither residual tumor nor recurrent tumor was identified by imaging studies in any of the six patients. Our initial experience suggests that preoperative embolization for the treatment of hypervascular renal tumors might reduce blood loss during subsequent laparoscopic partial nephrectomy, especially in procedures in which the renal vessels are not clamped. Preoperative tumor embolization may also help prevent the disastrous effect of incomplete tumor resection. A longer follow-up will be necessary to confirm efficacy.