title: Surgery of non-spinal skeletal metastases in renal cell carcinoma: No effect of preoperative embolization?
abstract: OBJECTIVE
  Surgery for metastases of renal cell carcinoma has increased in the last decade. It carries a risk of massive blood loss, as tumors are hypervascular and the surgery is often extensive. Preoperative embolization is believed to facilitate surgery. We evaluated the effect of preoperative embolization and resection margin on intraoperative blood loss, operation time, and survival in non-spinal skeletal metastases of renal cell carcinoma.
  
  
  METHODS
  This retrospective study involved 144 patients, 56 of which were treated preoperatively with embolization. The primary outcome was intraoperative blood loss. We also identified factors affecting operating time and survival.
  
  
  RESULTS
  We did not find statistically significant effects on intraoperative blood loss of preoperative embolization of skeletal non-spinal metastases. Pelvic localization and large tumor size increased intraoperative blood loss. Marginal resection compared to intralesional resection, nephrectomy, level of hemoglobin, and solitary metastases were associated with better survival.
  
  
  CONCLUSIONS
  Tumor size, but not embolization, was an independent factor for intraoperative blood loss. Marginal resection rather than intralesional resection should be the gold standard treatment for skeletal metastases in non-spinal renal cell carcinoma, especially in the case of a solitary lesion, as this improved the overall survival.
authors.affiliation: a Department of Orthopaedics , Unit of Musculoskeletal Surgery, Tampere University Hospital , Tampere .|b Department of Hand Surgery , Helsinki University Central Hospital , Helsinki .
authors.forename: Maire
authors.initials: M
authors.lastname: Ratasvuori
authors.affiliation: c Medical Imaging Center, Department of Radiology , Tampere University Hospital , Tampere , Finland .
authors.forename: Niko
authors.initials: N
authors.lastname: Sillanpää
authors.affiliation: d Department of Orthopedics , Karolinska University Hospital, Karolinska Institute , Stockholm , Sweden .
authors.forename: Rikard
authors.initials: R
authors.lastname: Wedin
authors.affiliation: e Department of Orthopedics , Haukeland University Hospital , Bergen , Norway .
authors.forename: Clement
authors.initials: C
authors.lastname: Trovik
authors.affiliation: f Department of Orthopedics , University Hospital , Aarhus , Denmark.
authors.forename: Bjarne H
authors.initials: BH
authors.lastname: Hansen
authors.affiliation: a Department of Orthopaedics , Unit of Musculoskeletal Surgery, Tampere University Hospital , Tampere .
authors.forename: Minna
authors.initials: M
authors.lastname: Laitinen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001859:Bone Neoplasms / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D002292:Carcinoma, Renal Cell / Q000556:secondary / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome