The role of arterial embolization in renal cell carcinoma
The role of arterial embolization in renal cell carcinoma
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DOI：
10.1080/003655999750015934
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发表时间：
1999-06-01
影响因子：
--
通讯作者：
Varenhorst, E
中科院分区：
文献类型：
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作者：
Kalman, D;Varenhorst, E
25年前，动脉栓塞术被引入，以促进癌肾的手术切除或缓解症状，如不可切除的肿瘤出血。这种技术在医疗器械中的作用一直是文献中争论的一个来源。我们查阅了所有可用的文献。共评审论文389篇。51篇出版物和3225例病史符合明确的入组标准。到目前为止，还没有发表这种方法治疗肾癌的前瞻性随机研究。在大多数研究中，患者被分组在一起，而不考虑适应症，即术前或姑息治疗。很少有文章是前瞻性的或包含关于肿瘤分期、适应症和充分随访的明确信息。虽然我们不能肯定地区分栓塞对疾病进程的影响，但似乎术前完全的肾动脉栓塞有助于切除侵入大静脉的肿瘤。栓塞和手术之间的最佳延迟可能是一天。栓塞材料的选择是乙醇。姑息性栓塞术对不能手术的严重出血肿瘤似乎在大多数情况下是成功的。在肾细胞癌中实施肾动脉栓塞的科学依据较弱。我们认为应该进行对照试验或平行前瞻性队列研究来比较局部晚期肾癌栓塞治疗和不栓塞治疗。
Twenty-five years ago arterial embolization was introduced to facilitate the surgical excision of the carcinomatous kidney or to palliate symptoms, such as haemorrhage from non-resectable tumours. The role of this technique in the therapeutic armamentarium has been a source of debate in the literature. We reviewed all the available literature. A total of 389 papers were evaluated. Fifty-one publications and 3225 case histories met explicit entry criteria for inclusion. Until now no prospective randomized study of this approach to the management of renal carcinoma has been published. In the majority of studies the patients are grouped together irrespective of indication, i.e. pre-operative or palliative. Few articles are prospective or contain clear information regarding tumour stage, indication and adequate follow-up. Although we are not able to distinguish with certainty the effect of embolization on the course of the disease, it seems that complete pre-operative renal artery embolization facilitates the excision of large vein-invading tumours. The optimal delay between embolization and operation is probably one day. The embolization material of choice is ethanol. Palliative embolization in non-operable tumours with serious haemorrhage seems to have been successful in most cases. The scientific basis for the implementation of renal artery embolization in renal cell carcinoma is weak. We believe that either controlled trials or parallel prospective cohort studies should be undertaken to compare treatment of selected locally advanced renal carcinomas with and without embolization.