Bone metastases from renal cell carcinoma: preoperative embolization

Area of Science:

• Oncology
• Interventional Radiology
• Orthopedic Surgery

Background:

• Renal cell carcinoma (RCC) frequently metastasizes to bone, often requiring surgical intervention.
• Surgical repair of bone metastases can involve significant intraoperative blood loss.
• Preoperative embolization is a potential strategy to mitigate surgical bleeding.

Purpose of the Study:

• To evaluate the impact of preoperative embolization on blood loss during surgical repair of bone metastases from RCC.
• To assess long-term outcomes, including bone healing and patient survival, following embolization and surgery.

Main Methods:

• Sixteen patients with bone metastases from RCC underwent preoperative embolization using polyvinyl alcohol (PVA) particles or coils.
• Surgery was performed within 24 hours or 36-120 hours post-embolization.
• Tumor stain obliteration, estimated blood loss (EBL), bone healing, and survival were assessed.

Main Results:

• Tumor stain obliteration exceeded 70% in 12 patients.
• Mean EBL was 533 mL, significantly lower (460 mL vs 750 mL; P < .01) when tumor stain obliteration was >70%.
• No significant difference in EBL was observed based on the timing of surgery (within 24 hours vs. >36 hours) when PVA was used. All patients achieved bone healing.

Conclusions:

• Preoperative embolization effectively reduces intraoperative blood loss in patients undergoing surgery for RCC bone metastases.
• Optimal reduction in blood loss is achieved with >70% tumor stain obliteration.
• Embolization did not adversely affect bone healing, and long-term survival ranged from 3 to 56 months.