Editorial Comment from Dr Chang to Decompressive surgery in combination with preoperative transcatheter arterial embolization: Successful improvement of ambulatory function in renal cell carcinoma patients with metastatic extradural spinal cord compression

Abstract

Suzuki et al.1 performed spinal cord decompression and fixation surgery in combination with preoperative embolization in six non-ambulatory patients due to epidural metastasis from renal cell cancer. After surgery, all patients regained ambulatory function. Suzuki et al.1 presented the necessity of surgical decompression for the preservation of neurological function in cases of metastatic epidural spinal cord compression from renal cell carcinoma (RCC). For the treatment of vertebral metastasis from RCC, radiation therapy is frequently adopted as the first treatment modality. However, in symptomatic metastatic epidural spinal cord compression, radiotherapy has a limited role. In cases in which neurological deficit is progressing despite radiation therapy, emergent surgical decompression should be considered. In most cases in which surgical decompression is performed on time, neurological recovery can be achieved. Ambulatory function is associated with quality of life and prolonged survival. Spinal metastasis of RCC is a highly vascular tumor and intraoperative bleeding was estimated to be in the range 1100–2600 mL even after embolization. Preoperative embolization of spinal tumors is often used to decrease intraoperative blood loss and improve resectability. Its effectiveness in decreasing intraoperative bleeding is definite for spinal metastasis of RCC. Complete embolization of tumors resulted in lower intraoperative blood loss compared with partial embolization and the male gender was associated with increased blood loss.2 The more levels that embolized, the greater the decrease in blood loss.2 The importance of surgical decompression and preoperative embolization in epidural spinal cord compression of RCC should be emphasized to physicians who treat urological cancers. None declared.