Unclamped nephron-sparing surgery with preoperative selective arterial embolization for the management of bilateral giant renal angiomyolipomas

Laparoscopic partial nephrectomy with prior superselective embolisation as treatment for giant renal angiomyolipoma

OBJECTIVE

Cases of giant renal angiomyolipoma (>9cm) are a therapeutic challenge due to their low frequency and large size. The treatment objective for patients with renal angiomyolipoma should be complete tumour extirpation, with a nephron-sparing surgical technique, without complications and using a minimally invasive approach.

MATERIAL AND METHODS

We present 3 cases of giant angiomyolipoma (10 12 and 14cm) treated with a combined approach: superselective embolisation and subsequent laparoscopic partial nephrectomy, in 3 separate hospitals.

RESULTS

None of the cases required conversion to open surgery. One of the 3 patients underwent arterial clamping, and none of the patients had complications.

CONCLUSIONS

The combined approach provides a procedure with the criteria of minimal invasiveness, nephron sparing, little bleeding and reduced warm ischaemia time.

Effectiveness and safety of laparoscopic enucleation combined with selective arterial embolization for renal angiomyolipoma

OBJECTIVE

This study aims to investigate the clinical value of laparoscopic enucleation combined with selective arterial embolization for the treatment of renal angiomyolipoma.

METHODS

Data of patients who underwent laparoscopic nephron-sparing surgery for renal angiomyolipoma between July 2013 and November 2014 in our center were analyzed.

RESULTS

Before surgery, 19 patients underwent selective arterial embolization, while 24 patients did not receive this treatment. Intraoperative blood loss was 46.4 ± 20.6 ml in the embolization group and 89.5 ± 30.4 ml in the non-embolization group (P= 0.000). Operation time was 90.3 ± 21.1 minutes in the embolization group and 131.7 ± 18.6 minutes in the non-embolization group (P= 0.000). Warm ischemia time was 9.5 ± 5.7 minutes in the embolization group and 24.2 ± 4.8 minutes in the non-embolization group (P= 0.001). Hospitalization time was 7.7 ± 1.1 days in the embolization group and 6.3 ± 1.3 days in the non-embolization group (P= 0.000). No serious complications occurred in patients in the embolization group, while one patient developed urinary leakage and another patient had angiomyolipoma in the operation area in the non-embolization group. Three months after the operation, serum creatinine level was 70.1 ± 13.7 μ mol/L in the embolization group and 84.2 ± 9.1 μ mol/L in the non-embolization group (P= 0.000). No tumor recurrence occurred in patients in both groups.

CONCLUSION

Compared with laparoscopic partial nephrectomy alone, tumor enucleation combined with selective arterial embolization can reduce blood loss and shorten warm ischemia time.

Transarterial embolization for renal angiomyolipomas: A single centre experience in 79 patients

Objective To evaluate the long-term efficacy and safety of selective arterial embolization (SAE) in the treatment of renal angiomyolipomas (AMLs). Methods This was a retrospective review of medical records and imaging findings from patients with renal AMLs who attended our clinic and received SAE between January 2007 and January 2014. Only patents with complete medical records, preoperative computed tomography scans using typical imaging and follow-up data were included. Results A total of 79 patients were enrolled in the study. Technical and clinical success rates were 100% and 91% ( n = 72), respectively. Only two patients experienced major complications. Post-embolization syndrome (i.e. fever, abdominal pain, nausea or vomiting) was reported in 68 (86%) patients, but all symptoms were mild and resolved with conservative measures. Mean radiological and clinical follow-up periods were 16.8 and 35.9 months, respectively. In 75 (95%) patients, tumours decreased in size; mean ± SD tumour size significantly decreased from 8.4 ± 3.5 cm pre-embolization to 6.7 ± 3.0 cm post-embolization . Conclusions This study provides long-term evidence that SAE is a safe and effective method in the treatment of patients with renal AMLs.

Total nephrectomy with nephron-sparing surgery for a giant bilateral renal angiomyolipoma: A case report

The current report presents the case of a 50-year-old female who presented with a giant bilateral renal angiomyolipoma (AML). After assessing the patient's symptoms, the tumor size and renal function, the patient underwent a total nephrectomy for the right AML, which measured 28×20×14 cm and nephron-sparing surgery was performed without preoperative selective angiographic embolization for a further 3 AMLs in the left kidney, the largest of which had a diameter of 12 cm. The introperative bleeding volume was at an acceptable level and the renal function was stable. No local recurrence was observed and no dialysis was required during follow-up. The strategy of the treatment in this report should be considered when treating similar tumors.