Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma

Abstract

Intraoperative hemorrhage can sometimes be massive in patients with spinal metastasis of renal cell carcinoma (MRCC). Preoperative embolization and local hemostatic agents are routinely use in spinal tumor surgery, but there have been no comparisons between these methods. This report compares the efficiency of various methods of bleeding control and their influence on outcome and survival after decompression procedures for MRCC. This was a retrospective case-control study of 54 patients with hypervascular extraosseous MRCC. All patients underwent palliative decompression procedures. We compared two groups of patients stratified by methods of bleeding control. The first group (EMB) included 32 patients who underwent preoperative embolization of a tumor. The second group (HEM) consisted of 22 patients, treated surgically using intraoperative local hemostatic agents. The parameters under evaluation were blood loss volume, drainage loss, possible complications, time of hospital stay and survival. The median intraoperative blood loss for EMB group [1275 (95% CI 1175-1500) mL] was slightly less than the median in HEM group [1400 (95% CI 1050-1725) mL] without significant differences (p=0.681). The postoperative drainage loss in HEM group [250 (95% CI 140-325)mL] was significantly less than that in EMB group [500 (95% CI 425-550)mL] (p=0.013). The complication rate (infections, hematomas, neurological deficit) was nearly equal in all groups. No statistically significant difference in overall survival was found between groups: EMB-26months (1year-93.3%, 3years-26.7%) and HEM-24months (1year-95.2%, 3years-16.3%) (p=0.360). Our results suggest that not all patients with MRCC require preoperative embolization, because usage of modern hemostatic agents can be an alternative bleeding control method.