Article
Effects of preoperative embolization on intraoperative blood loss in spinal metastases from renal cell carcinoma
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Published: | June 18, 2018 |
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Objective: Analyzing the effects of preoperative embolization on intraoperative blood loss in spinal surgery for renal cell carcinoma (rcc) metastasis and identifying factors contributing to an increased blood loss in the surgical procedure.
Methods: A retrospective analysis was performed patients who were treated in for spinal metastasis from rcc between 2011-2016. Factors analyzed were reduction of tumor blush, timing of embolization, selective vs. super-selective approach, surgical factors and tumor volume and localization. Parameters were statistically correlated with intraoperative blood loss (Hemoglobin (Hg)-decrease, blood-loss in ml, number of transfused blood bags.
Results: 25 patients with 34 surgical interventions were included. 17 cases were treated super-selectively, 11 selectively. Mean perioperative blood loss was 2248ml ± 1833ml. Higher blood loss was detected for vertebra replacement compared to percutaneous procedures (Hg decrease 4.22 vs. 2.62, p<0.05). Blood loss increased with increasing tumor volumes (0-50ccm / 50-100ccm / >100ccm) for Hg loss (3.29 / 3.64 / 4.24 mg/dl, NS), blood loss in ml (1291 / 2620 / 4971ml, p<0.001) and number transfusions (1.2 / 3.4 / 7.0, p<0.001). Stratifying by the grade of embolization, no significant differences were found between the groups (>90% / 90-75% / 75-50%) for Hg loss, blood loss, or number of transfusions.
Conclusion: Endovascular embolization for rcc metastasis of the spine is a safe procedure, however in this cohort, patients undergoing embolization did not show a reduced blood loss in comparison to the non-embolized cohort. Additional factors contributing to an increased blood loss were tumor size, and mode of surgery.