Pre-Operative Embolisation of Musculoskeletal Tumours - A Single Centre Experience.

Wong Sj,Urlings T,Tan Mh,Leong S,Tan Bs,Seng C

doi:10.5704/moj.2003.007

Abstract

Introduction:The management of musculoskeletal tumours is complex and requires a multi-disciplinary approach. Preoperative embolisation can be often employed to reduce intra-operative blood loss and complication rates from surgery. We report our experience with the safety, technical success and efficacy of pre-operative embolisation in musculoskeletal tumours.Materials and Methods:Thirteen consecutive patients who underwent pre-operative embolisation of a musculoskeletal tumour followed by surgical intervention at our institution from May 2012 to January 2016 were enrolled into the study. Patient demographics, tumour characteristics, embolisation techniques and type of surgery were recorded. Technical success of embolisation, amount of blood loss during surgery and transfusion requirements were estimated.Results:There were five female and eight male patients who underwent pre-operative embolisation during the study period. The age ranged between 16 to 68 years, and the median age was 54. Technical success was achieved in all patients. Mean intra-operative blood loss was 1403ml, with a range of 150ml to 6900ml. Eight patients (62%) required intra-operative blood products of packed red blood cells and fresh frozen plasma. No major complications occurred during embolisation.Conclusion:Pre-operative trans-arterial embolisation is feasible and safe for a variety of large and hypervascular musculoskeletal tumours. Our small series suggests that preoperative embolisation could contribute to the reduction of the intra-operative and post-operative blood product transfusion. It should be considered as a pre-operative adjunct for major tumour resections with a high risk of bleeding. The use of the haemoglobin gap complemented the assessment of perioperative blood loss.

Highlights

The management of musculoskeletal tumours is complex and requires a multi-disciplinary approach
We aimed to report on our experience and add onto the knowledge of safety, technical success and efficacy of pre-operative embolisation in musculoskeletal tumours
Two cases underwent two-stage embolisation for adequate devascularisation, as they were for hypervascular tumours; a metastatic thyroid carcinoma and a spindle cell sarcoma

Summary

Introduction

The management of musculoskeletal tumours is complex and requires a multi-disciplinary approach. Preoperative embolisation can be often employed to reduce intra-operative blood loss and complication rates from surgery. We report our experience with the safety, technical success and efficacy of pre-operative embolisation in musculoskeletal tumours. Amount of blood loss during surgery and transfusion requirements were estimated. Our small series suggests that preoperative embolisation could contribute to the reduction of the intra-operative and post-operative blood product transfusion. It should be considered as a pre-operative adjunct for major tumour resections with a high risk of bleeding. The main aim of pre-operative embolisation was to achieve devascularisation of the tumour before surgical resection, with reduction of intra-operative blood loss and complication rates[10,11]. Resection was preferred following embolisation, as revascularisation was seen at six weeks in some series[5]

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