Department of Spine Surgery, University Hospital, 1, place de l'Hôpital, B.P. 426, 67091 Strasbourg cedex, France.
Orthop Traumatol Surg Res. 2012 Sep;98(5):536-42. doi: 10.1016/j.otsr.2012.03.008. Epub 2012 Jul 17.
Preoperative embolization decreases the intraoperative risk of hemorrhage in spinal decompression surgery of hypervascular metastases such as renal cell carcinoma. There is no consensus concerning embolization in other metastases. The purpose of this study was to compare the intraoperative amount of blood loss in embolized versus non-embolized patients, seeking for differences depending on the primary tumor and the extent of surgery.
Ninety-three patients, average age 60.5 years, were operated. The origins of metastases were: 28 breast cancer (30.1%), 19 pulmonary carcinoma (20.4%), 16 renal cell carcinoma (17.2%), 30 other cancers (32.3%). Surgical procedures were: 52 thoracolumbar laminectomies with instrumentation, 29 thoracolumbar corpectomies or vertebrectomies, 12 cervical corpectomies. A preoperative microsphere embolization was performed in 35 patients. Blood loss was evaluated by: blood volume in surgical aspiration devices, number of transfused packed red blood cells units and hemoglobin variation during surgery.
Renal metastases were systematically embolized. In the breast group, there was no significant difference (P>0.05) in blood loss between embolization versus non-embolization. In the pulmonary group and in other metastases, no difference was found either. The extent of surgery (corpectomy/vertebrectomy versus thoracolumbar instrumentation and cervical corpectomy) increased bleeding: breast 1775ml versus 778ml and 600ml respectively (P=0.048), pulmonary 2500ml versus 430ml and 180ml (P=0.020), renal 3346ml versus 1175ml and 780ml (P=0.036) and others 1550ml versus 474ml and 400ml (P=0.020).
Embolization decreases the risk of hemorrhage in highly vascularized metastases such as renal cell carcinoma. A benefit of embolization was not found for metastases of breast or pulmonary tumors. As far as other metastases, thyroid carcinoma should be analyzed on a greater cohort. The extent of surgery remains an important risk factor for intraoperative bleeding. A preoperative angiogram should be carried out in all types of metastases prior to a thoracolumbar corpectomy or vertebrectomy to perform an embolization if the tumor is hypervascular.
Level IV, retrospective study.
术前栓塞可降低肾细胞癌等富血管转移灶脊柱减压手术中术中出血的风险。对于其他转移灶，栓塞是否有作用尚无共识。本研究旨在比较栓塞和非栓塞患者的术中出血量，同时寻找与原发肿瘤和手术范围相关的差异。
93 名患者，平均年龄 60.5 岁，接受手术治疗。转移灶起源于：28 例乳腺癌（30.1%）、19 例肺癌（20.4%）、16 例肾细胞癌（17.2%）、30 例其他癌症（32.3%）。手术方式为：52 例胸腰椎板切除术和内固定术、29 例胸腰椎椎体切除术或全椎体切除术、12 例颈椎椎体切除术。35 例患者行术前微球栓塞术。通过手术吸引装置中的血量、输血量和术中血红蛋白变化评估出血量。
肾转移灶均行系统栓塞。在乳腺癌组，栓塞与非栓塞之间的出血量无显著差异（P>0.05）。在肺癌组和其他转移灶中也未发现差异。手术范围（椎体切除术/全椎体切除术与胸腰椎内固定术和颈椎椎体切除术）增加了出血：乳腺癌组分别为 1775ml 比 778ml 和 600ml（P=0.048）、肺癌组分别为 2500ml 比 430ml 和 180ml（P=0.020）、肾细胞癌组分别为 3346ml 比 1175ml 和 780ml（P=0.036）、其他肿瘤组分别为 1550ml 比 474ml 和 400ml（P=0.020）。
栓塞可降低肾细胞癌等富血管转移灶术中出血的风险。对于乳腺癌或肺癌转移灶，栓塞并无获益。对于其他转移灶，甲状腺癌应在更大的队列中进行分析。手术范围仍是术中出血的重要危险因素。所有类型的转移灶行胸腰椎椎体切除术或全椎体切除术前行术前血管造影，如果肿瘤富血供，应行栓塞。
IV 级，回顾性研究。
