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. 2021 Jan 19:10:597476.
doi: 10.3389/fonc.2020.597476. eCollection 2020.

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

Yining Gong  1   2 , Changming Wang  3 , Hua Liu  2 , Xiaoguang Liu  1 , Liang Jiang  1
Affiliations

Only Tumors Angiographically Identified as Hypervascular Exhibit Lower Intraoperative Blood Loss Upon Selective Preoperative Embolization of Spinal Metastases: Systematic Review and Meta-Analysis

Yining Gong et al. Front Oncol. .

Abstract

Background: The role of preoperative embolization (PE) in reducing intraoperative blood loss (IBL) during surgical treatment of spinal metastases remains controversial.

Methods: A systematic search was conducted for retrospective studies and randomized controlled trials (RCTs) comparing the IBL between an embolization group (EG) and non-embolization group (NEG) for spinal metastases. IBL data of both groups were synthesized and analyzed for all tumor types, hypervascular tumor types, and non-hypervascular tumor types.

Results: In total, 839 patients in 11 studies (one RCT and 10 retrospective studies) were included in the analysis. For all tumor types, the average IBL did not differ significantly between the EG and NEG in the RCT (P = 0.270), and there was no significant difference between the two groups in the retrospective studies (P = 0.05, standardized mean difference [SMD] = -0.51, 95% confidence interval [CI]: -1.03 to 0.00). For hypervascular tumors determined as such by consensus (n = 542), there was no significant difference between the two groups (P = 0.52, SMD = -0.25, 95% CI: -1.01 to 0.52). For those determined as such using angiographic evidence, the IBL was significantly lower in the EG than in the NEG group, in the RCT (P = 0.041) and in the retrospective studies (P = 0.004, SMD = -0.93, 95% CI: -1.55 to -.30). For IBL of non-hypervascular tumor types, both the retrospective study (P = 0.215) and RCT (P = 0.947) demonstrated no statistically significant differences in IBL between the groups.

Conclusions: Only tumors angiographically identified as hypervascular exhibited lower IBL upon PE in this study. Further exploration of non-invasive methods to identify the vascularity of tumors is warranted.

Keywords: angiography; hypervascular tumor; intraoperative blood loss; preoperative embolization; spinal metastases; systematic review and meta-analysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow of patients in each phase.
Figure 2
Figure 2
Analysis of intraoperative blood loss in all tumor types. EG, embolization group; NEG, non-embolization group; SD, standard deviation; CI, confidence interval; IV, inverse variance; SE, standard error; SMD, standardized mean difference.
Figure 3
Figure 3
Analysis of intraoperative blood loss in hypervascular tumors determined as such by consensus. EG, embolization group; NEG, non-embolization group; SD, standard deviation; CI, confidence interval; IV, inverse variance; SE, standard error; SMD, standardized mean difference.
Figure 4
Figure 4
Analysis of intraoperative blood loss in hypervascular tumors determined as such using angiographic evidence. EG, embolization group; NEG, non-embolization group; SD, standard deviation; CI, confidence interval; IV, inverse variance; SE, standard error; SMD, standardized mean difference.
See this image and copyright information in PMC

References

    1. Truumees E, Dodwad SN, Kazmierczak CD. Preoperative embolization in the treatment of spinal metastasis. J Am Acad Orthop Surg (2010) 18:449–53. 10.5435/00124635-201008000-00001 - DOI - PubMed
    1. Gong Y, Xu L, Zhuang H, Liang J, Feng W, Zhongjun L, et al. Efficacy and safety of different fractions in stereotactic body radiotherapy for spinal metastases: A systematic review. Cancer Med (2019) 8:6176–84. 10.1002/cam4.2546 - DOI - PMC - PubMed
    1. Nater A, Sahgal A, Fehlings M. Management - spinal metastases. Handb Clin Neurol (2018) 149:239–55. 10.1016/B978-0-12-811161-1.00016-5 - DOI - PubMed
    1. Zaborovskii N, Ptashnikov D, Mikaylov D, Masevnin S. Oleg Smekalenkov. Preoperative embolization and local hemostatic agents in palliative decompression surgery for spinal metastases of renal cell carcinoma. Eur J Orthop Surg Traumatol (2018) 28:1047–52. 10.1007/s00590-018-2162-6 - DOI - PubMed
    1. Wirbel RJ, Roth R, Schulte M, Bernd K, Wolf M. Preoperative embolization in spinal and pelvic metastases. J Orthop Sci (2005) 10:253–7. 10.1007/s00776-005-0900-1 - DOI - PubMed

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