Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ 07103, United States of America.
Division of Vascular and Interventional Radiology, Department of Radiology, Rutgers - New Jersey Medical School, 185 South Orange Ave. MSB F-560, Newark, NJ 07103, United States of America.
Clin Imaging. 2021 Aug;76:205-212. doi: 10.1016/j.clinimag.2021.04.021. Epub 2021 May 3.
To evaluate the safety and efficacy of preoperative renal artery embolization of renal cell carcinoma in reducing intraoperative blood loss during subsequent partial nephrectomy through a systematic review and meta-analysis of current literature.
The PubMed database was searched for articles published from 1970 to 2018 describing patients with renal cell carcinoma who underwent partial nephrectomy with and without preoperative embolization of the tumor. Demographic data, procedural techniques, and surgical outcomes were obtained when available. A random-effects meta-analysis was performed to determine estimated blood loss in both groups of patients.
The literature search identified 14 relevant articles for systematic review, of which 4 articles provided sufficient data to be included in the meta-analysis. 270 patients (173 males, 97 females) underwent partial nephrectomy for RCC, of whom 222 received pre-operative embolization. There were 48 patients in our cohort that underwent partial nephrectomy for RCC without preoperative embolization. Random-effects meta-analysis demonstrated a significant difference between EBL in patients undergoing RAE prior to partial nephrectomy vs partial nephrectomy without preoperative embolization, with EBL of 154.0 ± 22.6 mL (n = 222) and 353.4 ± 69.6 mL (n = 478), respectively (p < 0.0001). Major complications occurred in 4.9% of patients undergoing pre-operative embolization followed by partial nephrectomy, whereas major complications occurred in 10.9% of patients undergoing partial nephrectomy without embolization (p = 0.01). Minor complications occurred in 5.8% of patients undergoing embolization and partial nephrectomy and in 19.0% of patients undergoing partial nephrectomy without embolization (p < 0.0001).
Renal artery embolization prior to surgical resection of renal cell carcinoma is safe and significantly reduces intraoperative blood loss in patients undergoing partial nephrectomy.
通过对当前文献的系统回顾和荟萃分析，评估术前肾动脉栓塞治疗肾细胞癌在减少随后部分肾切除术术中失血量的安全性和有效性。
检索 1970 年至 2018 年期间发表的描述接受部分肾切除术并伴有或不伴有肿瘤术前栓塞的肾细胞癌患者的文献。获取可用的人口统计学数据、手术技术和手术结果。对两组患者的估计失血量进行随机效应荟萃分析。
文献检索确定了 14 篇进行系统综述的相关文章，其中 4 篇文章提供了足够的数据纳入荟萃分析。270 例（173 例男性，97 例女性）患者因 RCC 接受部分肾切除术，其中 222 例接受术前栓塞。在我们的队列中有 48 例患者因 RCC 接受部分肾切除术而未行术前栓塞。随机效应荟萃分析显示，在接受肾动脉栓塞术的患者与未接受肾动脉栓塞术的患者之间，EBL 有显著差异，分别为 154.0±22.6ml（n=222）和 353.4±69.6ml（n=478）（p<0.0001）。接受术前栓塞并随后进行部分肾切除术的患者中发生 4.9%的重大并发症，而未接受栓塞并进行部分肾切除术的患者中发生 10.9%的重大并发症（p=0.01）。接受栓塞和部分肾切除术的患者中有 5.8%发生轻微并发症，而未接受栓塞并进行部分肾切除术的患者中有 19.0%发生轻微并发症（p<0.0001）。
肾细胞癌手术切除前进行肾动脉栓塞是安全的，可显著减少接受部分肾切除术的患者术中失血量。
