Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization

Authors

  • Stephen Faddegon Department of Urologic Sciences, University of British Columbia, Vancouver, BC

DOI:

https://doi.org/10.5489/cuaj.758

Abstract

Background: Angiomyolipoma (AML) is a benign renal neoplasm.
First-line therapy includes renal preserving surgery or angioembolization
(RAE), both with good outcomes in isolated studies.
However, there are no comparative randomized trials and no clinical
guidelines to help clinicians decide between these treatment
modalities. Our study examines the patterns of AML treatment at
a tertiary care centre to evaluate how local urologists have been
treating this disease.

Methods: This is a retrospective study of all AMLs treated at the
Vancouver General Hospital (Vancouver, BC, Canada) over the
past 10 years with either RAE or surgical excision. Searches were
performed of the radiology and pathology dictation systems, using
the following keywords: AML, angiomyolipoma, angioembolization,
embolization, surgery, partial nephrectomy and nephrectomy.

Results: At our institution, more AMLs were treated by surgery
than angioembolization (42 vs. 17 cases). Angioembolization was
more often chosen for cases of multifocal AML (35% vs. 7%) and
acute hemorrhage (50% vs. 14%). In the angioembolization cases,
particles were the embolic agent of choice (used 40% of the time).

Conclusions: Angioembolization allows rapid patient stabilization
in cases of acute hemorrhage, and provides good renal preservation
in cases of multifocal AML. It may also be preferred in large
masses when partial nephrectomy is not feasible. Surgery should be
performed in cases of diagnostic uncertainty or complex vascular
anatomy not amenable to RAE. Prospective randomized studies are
needed to compare RAE and surgery to better define their indications
in sporadic AML.

Contexte : Un angiomyolipome (AML) est une tumeur bénigne du
rein. Le traitement de première intention comprend une chirurgie
de conservation rénale ou une angioembolisation rénale, qui
ont toutes deux donné de bons résultats dans des études isolées.
Cependant, aucun essai comparatif randomisé n’a été mené et il
n’existe pas de lignes directrices pour aider les cliniciens à choisir
entre ces modalités thérapeutiques. Notre étude a examiné les tendances
dans le traitement de l’AML à un centre de soins tertiaires
pour évaluer comment les urologues y traitent cette maladie.

Méthodologie : Il s’agit d’une étude rétrospective de tous les AML
traités au Vancouver General Hospital (Vancouver, C.-B., Canada)
au cours des 10 dernières années, soit par chirurgie de conservation
rénale ou par angioembolisation. Des recherches ont été effectuées
dans les systèmes de dictée vocale de radiologie et de pathologie
en utilisant les mots-clés anglais suivants : AML, angiomyolipoma,
angioembolization, embolization, surgery, partial nephrectomy et
nephrectomy.

Résultats : Dans notre établissement, plus de cas d’AML ont été
traités par chirurgie que par angioembolisation (42 cas contre 17).
L’angioembolisation a été plus souvent choisie dans les cas d’AML
multifocal (35 % contre 7 %) et d’hémorragie aiguë (50 % contre
14 %). Dans les cas traités par angioembolisation, les particules
ont été l’agent embolique privilégié (utilisées dans 40 % des cas).

Conclusions : L’angioembolisation permet de stabiliser rapidement
l’état du patient en cas d’hémorragie aiguë, et offre une bonne
conservation rénale en cas d’AML multifocale. Elle peut aussi être
préférable en présence de larges masses quand la néphrectomie
partielle n’est pas possible. La chirurgie doit être réalisée en cas
d’incertitude diagnostique ou d’anatomie vasculaire complexe ne
se prêtant pas à l’angioembolisation rénale. Des études prospectives
randomisées sont nécessaires pour comparer l’angioembolisation
rénale et la chirurgie afin de mieux définir leurs indications dans
les formes sporadiques d’AML.

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Author Biography

Stephen Faddegon, Department of Urologic Sciences, University of British Columbia, Vancouver, BC

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How to Cite

Faddegon, S. (2013). Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization. Canadian Urological Association Journal, 5(6), E138-E141. https://doi.org/10.5489/cuaj.758

Issue

Vol. 5 No. 6 (2011): December

Section

Original Research

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