Utility of Preoperative Renal Artery Embolization for Management of Renal Tumors With Inferior Vena Caval Thrombi

Abstract

To review our experience with radical nephrectomy and inferior vena cava thrombectomy (RNIVCT) to determine the utility of preoperative embolization. Preoperative embolization has been used as an adjunctive procedure to facilitate surgical resection of complex renal tumors. From 1990 to 2007, 225 patients with renal tumors and inferior vena cava thrombus underwent RNIVCT, including 135 patients who had undergone preoperative renal artery embolization and 90 patients who had not. The effect of embolization on perioperative morbidity and mortality, transfusion requirements, blood loss, and operative time was analyzed by comparing the 2 groups. The mean primary tumor size was similar in both groups; however, 67% of the RNIVCT embolization group vs 48% of the nonembolization group had retrohepatic (level III) or supradiaphragmatic (level IV) thrombus extension (P = .032). The RNIVCT embolization patients had a greater median number of perioperative units transfused (8 vs 4; P = .001), a longer operative time (390 vs 313 minutes; P < .001), more postoperative complications (43% vs 29%; P < .001), a longer intensive care unit stay (2 vs 0.5 days), and increased perioperative mortality (13% vs 3%; P = .017). No differences were found in intraoperative complications or length of hospitalization. Multivariate analysis showed a fivefold greater risk of perioperative death (adjusted odds ratio 5.5; P = .029) and a trend toward increased blood transfusion (regression coefficient 3.9; P = .08) with preoperative embolization. The results of our study have shown that routine preoperative renal artery embolization in patients undergoing RNIVCT does not provide any measurable benefit in reducing blood loss or complications and was associated with increased major perioperative complications and mortality.