MADRID, SPAIN (UroToday.com) - The 2014 European Association of Urology (EAU) guidelines recommended laparoscopic radical nephrectomy as the standard for T2 renal tumors. Large T2b tumors can be technically difficult due to tumor size, vascularity and venous engorgement, and parasitic vessels. The group investigated whether preoperative renal artery embolization (PRAE) prior to laparoscopic nephrectomy facilitated the procedure. In the open nephrectomy literature, it has been shown to reduce intraoperative blood loss and operative time.
From February 2013, 10 patients with large T2b renal masses who were scheduled to undergo an open radical nephrectomy were identified. These patients were consented for PRAE prior to laparoscopic nephrectomy. The exclusion criteria included active groin infections, aortic/femoral artery aneurysms, and previous vascular grafts. Patients were admitted on the day of surgery, and PRAE was performed by the interventional radiologist. Percutaneous renal arteriogram was performed followed by embolization of the distal ipsilateral renal artery. Immediately following this procedure, patients were transferred to the operative suite for laparoscopic nephrectomy.
Mean age of patients was 67.5 years (range 37-88). All patients tolerated PRAE and the procedure time was < 30 min. Mean tumor size was 18.6 cm (range 15-22.5). Mean estimated blood loss was 41 ml (10-200). Mean operative time was 90 minutes (range 90-135). There were no intraoperative complications. No open conversion or blood transfusions were required. Mean length of hospitalization was 4 days (4-7).
The group concluded that immediate PRAE for large T2b renal tumors facilitated the widespread use of the laparoscopic approach in this patient population. Additionally, it may enable experienced surgeons to follow the EAU recommendation for the use of laparoscopic approach for T2 renal tumors.
Presented by Pathak S.K.,1 Leveckis J.,3 Williams G.,2 Waldron I.,2 Yamani Q.,2 and Kamath S.2 at the 30th Annual European Association of Urology (EAU) Congress - March 20 - 24, 2015 - IFEMA - Feria de Madrid - Madrid, Spain
1Royal Hallamshire Hospital, Dept. of Urology, Sheffield, 2Doncaster Royal Infirmary, Dept. of Radiology, Doncaster, 3Doncaster Royal Infirmary, Dept. of Urology, Doncaster, UK
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Reported by Mohammed Haseebuddin, MD, medical writer for UroToday.com