Abstract No. 553 Preoperative embolization of bone cancers: tumor types, location, estimated blood loss, and blood transfusion requirements

Abstract

Osseous metastases of certain primary cancers are hypervascular, such as renal cell carcinoma (RCC), and lead to concern for life-threatening high intra-operative blood loss and high intra-operative blood transfusion requirements. Some primary bone cancers can also appear hypervascular and in certain locations hemorrhage can lead to significant complications, such as the spine. Preoperative embolization of hypervascular osseous tumors is thought to decrease intra-operative bleeding. To evaluate intra-operative blood loss and blood transfusions after preoperative embolization, we reviewed our experience with preoperative embolization of osseous cancers. We reviewed imaging and medical charts for preoperative embolization by interventional radiology at a large academic institution for the past 4 years. Patient demographics, tumor type, tumor location, embolic agent(s) used, date of procedure and surgery, estimated blood loss (EBL), blood products administered and complications were reviewed. Thirteen bony tumors had preoperative embolization followed by surgical resection. The majority of the cancers, 62%, were renal cell carcinoma, followed by non-squamous cell lung cancer, 15%. The majority of cases involved the lower extremity, 62%, followed by the upper extremity, 23%, followed by the spine, 15%. The mean EBL for spine cases was 2850 mL versus 619 mL for non-spine cases, which was significantly different (p < 0.05). The EBL for lower extremity cases was 726 mL and for upper extremity cases was 333 mL. The mean EBL for RCC cases was higher than non-RCC cases (1051 mL versus 763 mL) but not significantly different (p = 0.8). The average packed red blood cells transfused was also highest for spine cases, 3 units versus 1.1 for extremity cases but this was not significantly different. The mean number of blood transfusions was also not significantly different depending on tumor type. There were no reported complications. No complications were reported with any of the preoperative embolizations or subsequent surgeries. EBL was significantly higher for spine cases. The mean EBL for RCC cases was higher than non-RCC cases but not significantly different.