PREOPERATIVE SELECTIVE ARTERIAL EMBOLIZATION OF RENAL TUMOURS PRIOR LAPAROSCOPIC PARTIAL NEPHRECTOMY: INTRA/PERIOPERATIVE BLEEDING CONTROL EFFICACY AND SURGICAL DRAWBACKS

==inizio abstract==

With the aim of achieving a “no clamp” procedure while reducing the risk of intraoperative bleeding from the tumour bed during LPN in order to avoid or at least minimize warm ischemia, preoperative selective arterial renal embolization (SARE) efficacy and safety has been evaluated. We retrospectively reviewed 23 consecutive patients with incidental renal mass stage T1N0M0 and a mean age of 68 years who underwent SARE prior LPN in the period March 2010-November 2012 in our department. The mean pre-operative renal tumor size was 3,5 cm (range 2.2 – 6.3 cm). Tumour was located in the upper, mid and lower kidney in 4 (17,39%), 12 (52,1%), 6 (26%), respectively. Due to organizational reasons, in all cases SARE was performed 12-15 h before LPN. The extent of neoplastic area embolization was judged satisfactory in 16 out of 23 cases. Nontarget embolization occurred in 3 cases. After SAE, 15 patients (65%) developed postembolization syndrome of mild degree. Pedicle clamping was used in 4 patients (17.39 %). Overall, 1 patient had WIT>20 min. Mean operative time was 123 min (range 115 – 130) with a mean EBL of 250 ml (range 20 – 450). Although SARE aids minimizing intraoperative bleeding from tumour resection bed it presents several functional, surgical/oncologic and organizational drawbacks. Nevertheless, probably SARE prior LPN may be considered as a laparoscopic training aid in the early stage of learning curve. In selected patients with complex renal masses (size > 4 cm, partially endophytic) preoperative SARE might facilitate surgery by reduction of blood loss

==fine abstract==