Current Assessment of the Use of Angioembolization in Radical and Palliative Surgical Treatment of Kidney Cancer (Literature review)
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Abstract
The incidence of new cases of renal cell carcinoma (NCC) in recent years has been steadily increasing both in the world and in Ukraine, and is about 403,000 and 4,900 per year, respectively. This phenomenon is largely due to the growing popularity of imaging methods (ultrasound, CT, MRI) and increased life expectancy (NCC is associated with old age).
The important role of the kidneys in homeostasis maintaining, biological features of NCC (long latent course, susceptibility to recurrence, the likelihood of synchronous/metachronous contralateral kidney damage, high probability of metastases at the time of primary diagnosis), high risk of complications of surgical interventions stimulate organ-preserving ablation techniques. Trans-arterial embolization (TAE) is one of them. Its use is justified by the hypervascular nature of NCC. Presumably, blocking the blood supply to the tumor can reduce intraoperative blood loss, tumor volume, severity of pain, and hematuria. To date, a number of publications of retrospective/pilot studies and meta-analyzes have emerged that highlight the role of TAE in the treatment of NCC.
A non-systematic analysis of previous publications was conducted, which highlight the effects of trans-arterial embolization in neoadjuvant and palliative regimens in patients with NCC. Search for relevant publications was conducted by keywords in electronic databases and bibliographies of selected articles for analysis.
The results of retrospective and prospective studies of TAE before kidney resection or radical nephrectomy (RNE) do not provide clear evidence in its favor. A number of studies have shown that neoadjuvant TAE allows to: reduce blood loss, reduce the duration of surgery, minimize injury to surrounding tissues, conduct a more complete eradication of the tumor, expand the indications for surgery, increase the rates of 5 and 10 years of cancer-specific survival after radical intervention.
Other studies, on the other hand, have found no ability for TAE to improve cancer-specific and overall survival after RNE. Also, according to pilot data, TAE does not improve the results of surgical treatment of patients with NCC and inferior vena cava thrombosis. It was found that TAE before venacavatrombectomy is associated with greater: duration of surgery, perioperative mortality, frequency of postoperative complications. Percutaneous ablation in NCC T1 is comparable in results to radical surgical treatment, but is associated with a fairly high risk of bleeding (3.5–14%). It is shown that TAE (ethanol in combination with lipiodol or microspheres) before radiofrequency ablation (RA) to reduce the risk of bleeding and local recurrence in patients with an average tumor diameter of 3.6 cm (max – 9 cm).
The rationality of the combined use of TAE and cryoablation has not been conclusively proven. In patients with inoperable tumors or with contraindications to surgery, TAE can effectively control symptoms, achieve cytoreduction, and increase life expectancy. The effectiveness of TAE in the control of symptoms in palliative mode reaches 68-75%.
In pilot studies, it was found that the latest modifications of TAE with the addition of chemotherapeutics or radioactive substances in NCC can cause more pronounced cytoreduction according to CT with contrast.
Randomized placebo-controlled, sufficiently sampled studies are mandatory to establish the indications and effects of TAE in patients with NCC.
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