The application of preoperativerenal artery embolization in the right renal cell carcinomawith inferior vena cava tumor thrombus and renalhilum invasion
CHEN Xinran1,2, GAO Yu2, PENG Cheng2, NIU Shaoxi2, JIAO Qilong2, LI Shichao2, CAO Senming2, LI Xintao2, CUI Bo2, HUANG Qingbo2, WANG Baojun2, ZHANG Xu2, MA Xin2
1Medical School of Chinese PLA, Beijing 100853, China; 2Department of Urology, First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
Abstract：Objective: To evaluate the value of preoperative renal artery embolization（PRAE）in the treatment of the right renal cell carcinomawith inferior vena cava tumor thrombus（RCC-IVCTT）andrenalhiluminvasion. Methods: The clinical data of 105 patients with right RCC-IVCTT who underwent robotic surgery in our hospital during June 2013 and October 2020 was analyzed retrospectively. The complicated RCC-IVCTT was defined as difficulty in renal artery dissociation caused by intraoperative tumor invasion of surrounding tissues and hilar enlargement of lymph nodes.It was divided intotherapeutic group （17 patients） and control group （88 patients） according to PRAE and renalhilum invasion. By using propensity score matching method with 1：1 radio, the operative time, estimated blood loss, postoperative hospital stay, blood transfusion and progression of cancer were compared between the two groups, respectively. Results: A total of 17 were matched and baseline data between groups were comparable. Median operative time was 190 min, median estimated blood loss was 600 ml and 8 patients need blood transfusion in the therapeutic group while median operative time was 175 min, median estimated blood loss was 800 ml and 10 patients need blood transfusion in the control group. Median postoperative hospital stay was 7 d and primary tumor type was clear cell carcinoma in 14 patients in the therapeutic group while median postoperative hospital stay was 7.5 d and primary tumor type was clear cell carcinoma in 13 patients in the control group. The overall survival rate and progression-illness rate in the therapeutic group were 76.5% and 47.1% respectively while 52.9%and 58.8%in the control group. For the above data, there was no significant difference between the two groups（P>0.05）. Conclusion: PRAE can pretreat right renal artery and reduce the difficulty of surgery in the treatment of right RCC-IVCTT andrenalhilum invasion. However, further large sample studies are needed to evaluate application of PRAE.
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