https://doi.org/10.4081/aiua.2023.12018

A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary?

Vol. 95 No. 4 (2023)
Submitted: October 21, 2023
Accepted: November 2, 2023
Published: December 5, 2023
Renal artery embolization, Renal cell carcinoma, Radical nephrectomy
Abstract Views: 592
PDF: 319
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Authors

Gullyawan Rooseno
Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Lukman Hakim
Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.
Tarmono Djojodimedjo
tar_urology@yahoo.com
Department of Urology, Faculty of Medicine, Universitas Airlangga; Dr. Soetomo General-Academic Hospital, Surabaya, East Java, Indonesia.

Introduction: Radical nephrectomy for Renal Cell Carcinoma (RCC) is still the treatment of choice for all stages except for stage I and IV, which need patient selectivity. The purpose of Renal Artery Embolization (RAE) pre-operative before radical nephrectomy is to facilitate resection, reduce bleeding, and reduce the time to surgery, but the necessity of this procedure is still debatable. This study investigates the efficacy of pre-operative Renal Artery Embolization (PRAE) before radical nephrectomy for RCC patients. Methods: The systematic searches based on PRISMA guidelines were conducted in Pubmed, Scopus, Web of Science, Medrxiv, and ScienceDirect databases with pre-defined keywords. Both analyses, quantitative and qualitative, were performed to assess blood loss, transfusion rate, surgical time, Intensive Care Unit (ICU) stay, and hospital stay. Results: A total of 921 patients from 8 eligible studies were included. The blood loss was significantly lower in the PRAE group compared to the control group (p = < 0.00001; SMD -20 mL; 95%CI -0.29, -0.12). There is no statistically significant difference between RAE and without RAE in the transfusion rate nephrectomy (p = 0.53, OR 0.65; 95% CI 0.16, 2.57), mean operative time (p = 0.69; SMD 5.91; 95% CI -23.25, 35.07), mean length of hospital stay (p = 0.05; SMD 0.56; 95% CI 0.00, 1.12), and mean length of stay in the ICU (p = 0.45; SMD 11.61; 95% CI -18.35, 41.57) Conclusions: PRAE before radical nephrectomy significantly reduces blood loss in RCC patients but is similar in the surgical time, transfusion rate, and length of hospital stay and ICU stay.

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Crossref
Scopus
Google Scholar
Europe PMC
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA: a cancer journal for clinicians. 2019; 69:7-34. DOI: https://doi.org/10.3322/caac.21551
Umbas R, Safriadi F, Mochtar CA, et al. Urologic cancer in Indonesia. Jpn J Clin Oncol. 2015; 45:708-12. DOI: https://doi.org/10.1093/jjco/hyv066
Motzer RJ, Jonasch E, Agarwal N, et al. Kidney Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw.. 2022; 20:71-90.
Whiting D, Challacombe B, Madaan S, et al. Complications After Radical Nephrectomy According to Age: Analysis from the British Association of Urological Surgeons Nephrectomy Audit. J Endourol. 2022; 36:188-96. DOI: https://doi.org/10.1089/end.2021.0165
Zhang ZL, Li YH, Luo JH, et al. Complications of radical nephrectomy for renal cell carcinoma: a retrospective study comparing transperitoneal and retroperitoneal approaches using a standardized reporting methodology in two Chinese centers. Chin J Cancer. 2013; 32:461-8. DOI: https://doi.org/10.5732/cjc.012.10185
Almgård LE, Slezak P. Treatment of Renal Adenocarcinoma by Embolization. Eur Urol. 1977; 3:279-81. DOI: https://doi.org/10.1159/000472115
Li D, Pua B, Madoff D. Role of Embolization in the Treatment of Renal Masses. Semin intervent Radiol. 2014; 31:070-81. DOI: https://doi.org/10.1055/s-0033-1363845
Luo SH, Huang H, Chu JG, et al. Value of Nephrectomy Following Renal Artery Embolization vs. Nephrectomy Alone for Big Renal Cell Carcinoma: A Retrospective Analysis. Int J Radiol Med Imag. 2018; 4:126.
Kalman D, Varenhorst E. The Role of Arterial Embolization in Renal Cell Carcinoma. Scandinavian Journal of Urology and Nephrology. 1999; 33:162-70. DOI: https://doi.org/10.1080/003655999750015934
Shanmugasundaram S, Cieslak JA, Sare A, et al. Preoperative embolization of renal cell carcinoma prior to partial nephrectomy: A systematic review and meta-analysis. Clin Imaging. 2021; 76:205-12. DOI: https://doi.org/10.1016/j.clinimag.2021.04.021
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009; 339:b2700. DOI: https://doi.org/10.1136/bmj.b2700
Sterne JAC, Savovic J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: https://doi.org/10.1136/bmj.l4898
Bakal CW, Cynamon J, Lakritz PS, Sprayregen S. Value of Preoperative Renal Artery Embolization in Reducing Blood Transfusion Requirements during Nephrectomy for Renal Cell Carcinoma. J Vasc Interv Radiol. 1993; 4:727-31. DOI: https://doi.org/10.1016/S1051-0443(93)71958-2
Jaganjac S, Schefe L, Avdagi E, et al. Preoperative Kidney Tumor Embolization as Procedure for Therapy of Advanced Kidney Cancer. Acta Inform Med. 2014; 22:302. DOI: https://doi.org/10.5455/aim.2014.22.302-305
May M, Brookman-Amissah S, Pflanz S, et al. Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma. BJR. 2009; 82:724-31. DOI: https://doi.org/10.1259/bjr/17514226
Singsaas MW, Chopp RT, Mendez R. Preoperative renal embolization as adjunct to radical nephrectomy. Urology 1979; 14:1-4 DOI: https://doi.org/10.1016/0090-4295(79)90200-0
Tang G, Chen X, Wang J, et al. Adjuvant instant preoperative renal artery embolization facilitates the radical nephrectomy and thrombectomy in locally advanced renal cancer with venous thrombus: a retrospective study of 54 cases. World J Surg Onc. 2020; 18:206. DOI: https://doi.org/10.1186/s12957-020-01985-7
Subramanian VS, Stephenson AJ, Goldfarb DA, et al. Utility of Preoperative Renal Artery Embolization for Management of Renal Tumors With Inferior Vena Caval Thrombi. Urology. 2009; 74:154-9. DOI: https://doi.org/10.1016/j.urology.2008.12.084
Cochetti G, Zingaro MD, Boni A, et al. Renal artery embolization before radical nephrectomy for complex renal tumour: which are the true advantages? Open Medicine. 2019; 14:797-804. DOI: https://doi.org/10.1515/med-2019-0095
Caño Velasco J, Polanco Pujol L, Herranz Amo F, et al. Utility of preoperative vascular embolization of renal tumors with left renal vein tumor thrombus. Actas Urológicas Españolas. 2021; 45:615-22. DOI: https://doi.org/10.1016/j.acuroe.2021.02.009
Davis C, Boyett T, Caridi J. Renal artery embolization: application and success in patients with renal cell carcinoma and angiomyolipoma. Semin Intervent Radiol. 2007; 24:111-6. DOI: https://doi.org/10.1055/s-2007-971185
Muller A, Rouvière O. Renal artery embolization—indications, technical approaches and outcomes. Nat Rev Nephrol. 2015; 11:288-301. DOI: https://doi.org/10.1038/nrneph.2014.231
Lionberg A, Jeffries J, Van Ha TG. Renal Artery Embolization for Neoplastic Conditions. Semin intervent Radiol. 2020; 37:420-5. DOI: https://doi.org/10.1055/s-0040-1715884
Panarese A, D’Anselmi F, De Leonardis M, et al. Embolization of the renal artery before graft nephrectomy: a comparing study to evaluate the possible benefits. Updates Surg. 2021; 73:2375-80. DOI: https://doi.org/10.1007/s13304-021-01018-2
Haochen W, Jian W, Li S, et al. Superselective renal artery embolization for bleeding complications after percutaneous renal biopsy: a single-center experience. J Int Med Res. 2019; 47:1649-59. DOI: https://doi.org/10.1177/0300060519828528
Rochon P, Hu J. Renal Artery Embolization for Renal Biopsy Bleed. Semin intervent Radiol. 2016; 33:342-6. DOI: https://doi.org/10.1055/s-0036-1592322
Reinhart HA, Ghaleb M, Davis BR. Transarterial embolization of renal tumors improves surgical outcomes: A case series. Int J Surg Case Rep. 2015; 15:116-8. DOI: https://doi.org/10.1016/j.ijscr.2015.08.022
Naito S, Kato T, Tsuchiya N. Surgical and focal treatment for metastatic renal cell carcinoma: A literature review. Int J of Urology. 2022; 29:494-501. DOI: https://doi.org/10.1111/iju.14841
Schwartz MJ, Smith EB, Trost DW, Vaughan ED. Renal artery embolization: clinical indications and experience from over 100 cases. BJU Int. 2007; 99:881-6. DOI: https://doi.org/10.1111/j.1464-410X.2006.06653.x

How to Cite

Rooseno, G., Hakim, L., & Djojodimedjo, T. (2023). A systematic review and meta-analysis on the efficacy of preoperative renal artery embolization prior to radical nephrectomy for renal cell carcinoma: Is it necessary?. Archivio Italiano Di Urologia E Andrologia, 95(4). https://doi.org/10.4081/aiua.2023.12018
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