Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Apr 28, 2016; 8(4): 378-389
Published online Apr 28, 2016. doi: 10.4329/wjr.v8.i4.378
Preoperative embolization of primary bone tumors: A case control study
Roushan Jha, Raju Sharma, Shishir Rastogi, Shah Alam Khan, Arvind Jayaswal, Shivanand Gamanagatti
Roushan Jha, Raju Sharma, Shivanand Gamanagatti, Department of Radiodiagnosis, All India Institute of Medical sciences, New Delhi 110029, India
Shishir Rastogi, Shah Alam Khan, Arvind Jayaswal, Department of Orthopedics, All India Institute of Medical sciences, New Delhi 110029, India
Author contributions: Jha R designed the research study; Sharma R helped with article design, literature search and article drafting; Rastogi S and Jayaswal A contributed to clinical perspective, revision of article and final approval; Khan SA contributed towards the article concept and revision; Gamanagatti S contributed equally to conception, critical revision and image preparation.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the All India Institute of Medical Sciences.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Technical Appendix, images and data set available from the corresponding author at shiv223@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shivanand Gamanagatti, Additional Professor, Department of Radiodiagnosis, All India Institute of Medical Sciences, Room No 81-B, Ansari Nagar, New Delhi 110029, India. shiv223@gmail.com
Telephone: +91-11-26594567 Fax: +91-11-26588663
Received: September 9, 2015
Peer-review started: September 12, 2015
First decision: October 8, 2015
Revised: December 24, 2015
Accepted: January 27, 2016
Article in press: January 29, 2016
Published online: April 28, 2016
Abstract

AIM: To study the safety and effectiveness of preoperative embolization of primary bone tumors in relation to intraoperative blood loss, intraoperative blood transfusion volume and surgical time.

METHODS: Thirty-three patients underwent preoperative embolization of primary tumors of extremities, hip or vertebrae before resection and stabilization. The primary osseous tumors included giant cell tumors, aneurysmal bone cyst, osteoblastoma, chondroblastoma and chondrosarcoma. Twenty-six patients were included for the statistical analysis (embolization group) as they were operated within 0-48 h within preoperative embolization. A control group (non-embolization group, n = 28) with bone tumor having similar histological diagnosis and operated without embolization was retrieved from hospital record for statistical comparison.

RESULTS: The mean intraoperative blood loss was 1300 mL (250-2900 mL), the mean intraoperative blood transfusion was 700 mL (0-1400 mL) and the mean surgical time was 221 ± 76.7 min for embolization group (group I, n = 26). Non-embolization group (group II, n = 28), the mean intraoperative blood loss was 1800 mL (800-6000 mL), the mean intraoperative blood transfusion was 1400 mL (700-8400 mL) and the mean surgical time was 250 ± 69.7 min. On comparison, statistically significant (P < 0.001) difference was found between embolisation group and non-embolisation group for the amount of blood loss and requirement of blood transfusion. There was no statistical difference between the two groups for the surgical time. No patients developed any angiography or embolization related complications.

CONCLUSION: Preoperative embolization of bone tumors is a safe and effective adjunct to the surgical management of primary bone tumors that leads to reduction in intraoperative blood loss and blood transfusion volume.

Keywords: Bone tumor, Embolisation, Preoperative, Bloodloss, Surgery

Core tip: The current study shows that the preoperative embolisation of bone tumors performed 48 h prior to either limb salvage surgery or spinal stabilization leads to decrease in intraoperative blood loss and intraoperative blood transfusion volume. Therefore, would recommend that pre-operative embolisation is a safe procedure and should be used as part of the multi-disciplinary approach to the management of bone tumours in difficult anatomical locations especially those are known to be highly vascular.