Pre-operative renal arterial embolisation does not provide survival benefit in patients with radical nephrectomy for renal cell carcinoma

Br J Radiol. 2009 Aug;82(981):724-31. doi: 10.1259/bjr/17514226. Epub 2009 Mar 2.


Currently, there is no widespread use of percutaneous renal artery embolisation (PRAE) as a pre-operative treatment in the management of renal cell carcinoma (RCC). There is also a scarcity of studies concerning the potential benefits of this procedure. All patients with RCC who underwent pre-operative PRAE before nephrectomy (n = 227) and all patients solely undergoing surgery (n = 607) at our institution from 1992 to 2006 were included. Information on techniques used, perioperative transfusion requirements, pathological and clinical variables, acute toxicity and complications were obtained from a retrospective review of medical records. Propensity modelling techniques were used to compare cancer-specific survival (CSS) and overall survival (OS) in both groups. Propensity scores were calculated from a logistic matching model including age, gender, clinical tumour size, grading, pN stage, cM stage, pT stage, histology and microvascular invasion. This resulted in 189 matches. The mean follow-up of the entire group of matched patients was 81 months. The 5-year actuarial CSS and OS for the total group of matched patients was 80.8% and 73.9%, respectively. CSS and OS did not show any significant differences between the matched treatment groups. There were no statistical differences in surgical complications between all patients treated with pre-operative PRAE (n = 227) and all patients without PRAE (n = 607), except for blood transfusion (61% vs 24%; p<0.01). Symptoms of post-embolization syndrome, including lumbar pain, fever, nausea, hypertension and macroscopic haematuria, were reported by 202 patients (89%), in most cases being mild and self-limited. There is no conclusive evidence that pre-operative PRAE provides survival benefits in the management of surgically resected RCC.

MeSH terms

  • Aged
  • Carcinoma, Renal Cell / blood supply
  • Carcinoma, Renal Cell / mortality
  • Carcinoma, Renal Cell / therapy*
  • Case-Control Studies
  • Embolization, Therapeutic*
  • Female
  • Humans
  • Kidney Neoplasms / blood supply
  • Kidney Neoplasms / mortality
  • Kidney Neoplasms / therapy*
  • Male
  • Middle Aged
  • Nephrectomy*
  • Preoperative Care / methods*
  • Prognosis
  • Renal Artery / surgery*
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome