Preoperative embolization of bone tumors for decreased blood loss at resection: a multicenter review of technique and safety

Bone tumors of varying etiologies, both benign and malignant, may cause significant pain, pathologic fracture and impaired mobility of associated joints. Resection of these lesions can improve patient quality of life; however, excision carries morbidity and mortality from the risk of major perioperative bleeding. We report a multicenter review of technique and safety with preoperative embolization to minimize risk of major bleeding during subsequent resection of a range of bone tumors. Between September 2007 and July 2014, preoperative embolization of various bone tumors was performed in 27 patients by operators at two major academic medical centers. In all cases, subsequent resection was accomplished within 48 hours of embolization. Patient demographics, tumor characteristics, embolization technique and technical success rates, subsequent tumor resection technique and associated blood loss, hospital length of stay, and overall complication rates were evaluated. Bone lesions included RCC (n=17), follicular thyroid carcinoma (n=2), aneurysmal bone cyst (n=2), urothelial carcinoma (n=1), cholangiocarcinoma (n=1), medullary renal carcinoma (n=1), squamous cell carcinoma (n=1), plasmacytoma (n=1), and chondroblastoma (n=1). Tumor maximum dimension ranged from 1.6 cm to 9 cm (mean 5.3 cm, excluding one permeative lesion which could not be measured). Pathologic fracture was present or considered to be impending in 13 of 27 cases. Tumor arterial embolization was accomplished utilizing Embospheres (n=20; Merit Medical, Piscataway, NJ), Embozene (n=3; CeloNova Biosciences, San Antonio, TX) and Gelfoam (n=2; Pfizer, New York, NY) with 100% technical success. No complications were attributed to preoperative embolization and there were no delays to planned dates of tumor resection. Estimated blood loss during surgical resection ranged from 95 to 2500 mL (mean 718 mL). Preoperative embolization of a range of varying bone tumors for decreased blood loss at resection is feasible and safe with high technical success.