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First published online March 2, 2009
British Journal of Radiology (2009) 82, 724-731
© 2009 British Institute of Radiology
doi: 10.1259/bjr/17514226
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Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma

M MAY, MD 1 S BROOKMAN-AMISSAH, MD 1 S PFLANZ, MD 1 J ROIGAS, MD 2 B HOSCHKE, MD 1 and F KENDEL, PhD 3

1 Department of Urology, Carl-Thiem Hospital, Cottbus, Berlin, 2 Department of Urology, Vivantes-Clinic Am Urban, Berlin and 3 Institute of Medical Psychology, Charité - Universitätsmedizin Berlin, Germany

Correspondence: Matthias May, Department of Urology, Carl-Thiem Hospital Cottbus, University Teaching Hospital, Charité zu Berlin, Thiemstrasse 111, D-03048 Cottbus, Germany. E-mail: matthias.may1{at}web.de

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.






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