Surgery of non-spinal skeletal metastases in renal cell carcinoma

Figures & data

Figure 1. Preoperative embolization performed on a tumor measuring 13 cm located in the distal femur. Since only some residual peripheral tumor enhancement was seen, this was considered to be an adequate embolization outcome. A marginal resection and endoprosthetic replacement resulted in an IBL of 1.3

Figure 2. Preoperative embolization performed on a tumor with fracture in the proximal femur measuring 9 cm. Since a clear region of tumor enhancement (about 40% of the tumor) was seen in the lower parts of the tumor, this was considered to be a suboptimal embolization result. An intralesional resection and endoprosthetic replacement resulted in an IBL of 0.2 L.

Figure 3. Preoperative embolization performed on a proximal femur tumor measuring 5 cm. In the absence of any tumor enhancement, this was classified as an adequate embolization result. Intralesional resection and endoprosthetic replacement resulted in an IBL of 0.5 L.

Table 1. Baseline characteristics of patients with and without preoperative embolization for skeletal metastases from RCC

		With	Without
Variable	Total	embolization	embolization
No. of cases	148	56	92
Mean age (range)	67	67 (43–90)	67 (40–86)
Sex
Male	102	38	64
Female	46	18	28
Mean ASA	2.7	2.7	2.7
Nephrectomy	98	37	61
Organ metastases present	72	28	44
Solitary skeletal metastases	78	33	45
Mean tumor size (range), cm	6.4	7.1 (3–13)	6.0 (2–14)
Localization
Femur	82	30	52
Pelvis	15	9	6
Humerus	37	14	23
Other	14	5	11
Operation method
Marginal resection	45	20	25
Intralesional resction	103	36	67
Type of surgery
Tumor prosthesis	34	17	17
Prosthesis	42	22	20
Nailing	43	11	32
Other	26	5	21
Preoperative hemoglobin, g/L (range)		121 (88–197)	122 (82–175)
Mean estimated blood loss, L (range)	1.0	1.1 (0.005–5.7)	1.0 (0.005–12)
Mean operating time, min (range)	135	157 (65–420)	120 (45–420)
Mean survival time (range), months	12	11 (0–90)	14 (0–150)

Table 2. A comparison of the factors affecting intraoperative blood loss (IBL) in the different subgroups of cases with and without preoperative embolization, performed using the Mann-Whitney U-test

	With embolization			Without embolization			p-value
	N	Median	Q1–Q3	N	Median	Q1–Q3
Pelvis	9	1,800	(1,100–5,000)	6	1,525	(836–2,800)	0.5
Humerus	14	525	(340–625)	23	600	(200–1,020)	0.6
Femur	29	400	(275–850)	47	600	(200–900)	0.8
Prosthesis	22	500	(300–500)	20	875	(612–2,400)	0.2
Tumor prosthesis	17	600	(350–1,050)	17	400	(200–910)	0.2
Nailing and plating	9	200	(75–525)	26	375	(200–625)	0.2
Marginal resection	20	550	(350–875)	24	400	(200–725)	0.2
Intralesional removal	34	500	(300–1,650)	62	600	(238–1,210)	0.8

Table 5. Factors associated with survival (Cox regression analysis)

Variable	Exp.^a	95% CI	p-value
Hemoglobin under 100 g/L	2.0	1.2–3.5	0.01
Intralesional removal	2.2	1.4–3.3	0.001
Multiple bone metastases	1.5	1.1–2.2	0.03
No previous nephrectomy	1.7	1.2–2.6	0.008

a Exp: HR = Hazard rate