Immediate preoperative renal artery embolization in the resection of complex renal tumors (UroCCR-48 Reinbol study)
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UROLOGY - ORIGINAL PAPER
Immediate preoperative renal artery embolization in the resection of complex renal tumors (UroCCR‑48 Reinbol study) C. Alegorides1 · P. Bigot2 · J. Hardwigsen3 · V. Vidal4 · A. Riberi5 · M. Andre6 · B. Gondran‑Tellier1 · M. Baboudjian1 · F. Michel1 · G. Karsenty1 · E. Lechevallier1 · J. C. Bernhard7 · R. Boissier1 Received: 5 July 2020 / Accepted: 29 August 2020 © Springer Nature B.V. 2020
Abstract Purpose We evaluated the feasibility and outcomes of immediate preoperative renal artery embolization (IPRAE) before complex nephrectomy for locally advanced RCC ± inferior vena cava thrombus (IVCT). Methods A comparative retrospective (2007–2017) multicenter study which included 145 patients with locally advanced RCC ± IVCT: 99 radical nephrectomies vs. 46 radical nephrectomies with IPRAE identified in the prospective UroCCR national database (CNIL DR 2013–206; NCT03293563). IPRAE was performed under local anesthesia the day of nephrectomy ( 3 between embolization and surgery; – the impact of iodine injection (amount in mL) on postoperative renal function; –morbidity up to 30 postoperative days evaluated according to the Clavien-Dindo score.
Statistics Qualitative data are presented as counts and percentages and were assessed using the chi-square or Fisher exact test. Quantitative data are presented as the mean and standard deviation. Student t-test was used for normally distributed quantitative data. Two-tailed significance was considered at 0.05 for all statistical tests. Factors correlated to peroperative bleeding were identified in an analysis of covariance. All stats were performed with Xlstat (Addinsoft 2020.1.1, Paris, France).
Results Patients and tumor characteristics A total of 145 patients were included: 46 (32%) underwent IPRAE + RN and 99 (68%) underwent RN alone. The characteristics of the patients are reported in Table 1. The average age of the patients was 65 ± 1 years, 65% were male, the median Karnofsky index was 90% [50–100] with no significant difference between the embolized vs. the control groups (Table 1). Tumor characteristics are reported in Table 1. Tumor stages were: T2b 14%, T3a 41%, T3b 27%, T3c 13%, T4 5%, with 22% N1 and 28% M1, with no significant difference between the embolized and control groups (Table 1). Mean tumor size was 15 ± 3 vs. 9 ± 1 cm respectively in the embolized and control groups (P = 0.01). A tumor thrombus was reported in 86 (59%) of the tumors. IVCT levels according to the classification of Novick are reported in Table 1. We reported 51% of level III-IV IVCT in the embolized group vs. 29% in the control group (P = 0.02). The predominant histological subtype was clear cell RCC (79%), with 92% of high grade (Fuhrman grade III-IV).
Results of immediate preoperative renal artery embolization The radiological success rate was 98% (45/46). For 1/46 patients, a 1 mm superior polar division branch could not be embolized and only the trunk of the main renal artery was embolized. A total of 74 arteries were embolized in 46 patients: one artery in
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