CIO 2022-16 Preoperative Embolization in Bone and Soft Tissue Pelvic Tumors: An Experience in a Tertiary Care Oncology Center

Purpose: The purpose of this study is to evaluate the role of preoperative embolization in surgical management of patients with pelvic tumors.

Materials and Methods: This is a prospective study of 420 patients with large or hypervascular bone and soft tissue pelvic tumors who underwent preoperative embolization before surgical resection between June 2014 and December 2021. Initial angiograms of all possible blood vessels supplying the tumor were obtained followed by selective distal catheterization of the vessels demonstrating tumor blush. Embolization was achieved using polyvinyl alcohol particles with or without Gelfoam until there was significant reduction in tumor blush. Intraoperative blood loss was calculated as the difference between the volume in the suction container and the sterile irrigation fluid used plus difference between the dry and wet weight of surgical gauges and sponges used. The procedure was performed using GE INNOVA 41001Q in the cath lab.

Results: Mean estimated blood loss (EBL) in pelvic tumors was 1118 ± 852 mL. EBL increased with increased operating time showing strong positive correlation (r =0.678; P < 0.0001). EBL was more in patients with larger tumors. There was moderate positive correlation between EBL and maximum tumor dimension (r = 0.508; P < 0.0001). Mean packed red blood cells transfused during and within 48 hours after surgery were 2.9 ± 2.6 units. There was reduction in the mean duration of surgery, and ease of resection was better than expected. There was strong positive correlation between hospital stay and EBL (r = 0.71; P < 0.001).There were no major complications attributed to preoperative embolization.

Conclusions: Preoperative embolization in pelvic tumors reduces the EBL during surgery, leading to better delineation of the tumor margins, improving the ease of resection, and reducing the operating time and the number blood transfusions without any significant complications.