title: Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma.
abstract: Currently, there is no widespread use of percutaneous renal artery embolisation (PRAE) as a pre-operative treatment in the management of renal cell carcinoma (RCC). There is also a scarcity of studies concerning the potential benefits of this procedure. All patients with RCC who underwent pre-operative PRAE before nephrectomy (n = 227) and all patients solely undergoing surgery (n = 607) at our institution from 1992 to 2006 were included. Information on techniques used, perioperative transfusion requirements, pathological and clinical variables, acute toxicity and complications were obtained from a retrospective review of medical records. Propensity modelling techniques were used to compare cancer-specific survival (CSS) and overall survival (OS) in both groups. Propensity scores were calculated from a logistic matching model including age, gender, clinical tumour size, grading, pN stage, cM stage, pT stage, histology and microvascular invasion. This resulted in 189 matches. The mean follow-up of the entire group of matched patients was 81 months. The 5-year actuarial CSS and OS for the total group of matched patients was 80.8% and 73.9%, respectively. CSS and OS did not show any significant differences between the matched treatment groups. There were no statistical differences in surgical complications between all patients treated with pre-operative PRAE (n = 227) and all patients without PRAE (n = 607), except for blood transfusion (61% vs 24%; p<0.01). Symptoms of post-embolization syndrome, including lumbar pain, fever, nausea, hypertension and macroscopic haematuria, were reported by 202 patients (89%), in most cases being mild and self-limited. There is no conclusive evidence that pre-operative PRAE provides survival benefits in the management of surgically resected RCC.
authors.affiliation: Department of Urology, Carl-Thiem Hospital Cottbus, University Teaching Hospital, Charitézu Berlin, Thiemstrasse 111, Cottbus D-03048, Germany. matthias.may1@web.de
authors.forename: M
authors.initials: M
authors.lastname: May
authors.forename: S
authors.initials: S
authors.lastname: Brookman-Amissah
authors.forename: S
authors.initials: S
authors.lastname: Pflanz
authors.forename: J
authors.initials: J
authors.lastname: Roigas
authors.forename: B
authors.initials: B
authors.lastname: Hoschke
authors.forename: F
authors.initials: F
authors.lastname: Kendel
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000401:mortality / Q000628:therapy*; D016022:Case-Control Studies; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome