Emergency embolization in locally advanced cervical cancer: a case series in a tertiary referral center in Argentina

Abstract

Cervical cancer is the second most common cancer in women in South America. However, it represents the greatest impact on morbidity and mortality in women under 45. Among the most serious complications of cervical cancer, bleeding occupies a significant place, being the main symptom in advanced stages and leading to high morbidity and mortality. Uterine artery embolization is a minimally invasive method that consists of injecting an embolizing material into terminal vessels. The objective of this study is to describe cases of patients with advanced cervical cancer who required embolization of uterine arteries to control massive vaginal bleeding in a tertiary referral hospital. Materials and methods: This is an observational, retrospective study, conducted at Sanatorio Güemes, Buenos Aires between October 2017 and May 2023. We included patients that required embolization due to severe vaginal hemorrhage and diagnosis of locally advanced cervical cancer. Our Institution is one of the largest third-level centers in the city of Buenos Aires, receiving referrals for cervical cancer from other more disadvantaged regions of Argentina. Variables such as age, International Federation of Gynecology and Obstetrics stage, hemoglobin level, oncological treatment performed, embolization material, complications and re-embolization were analyzed. A univariate analysis was performed. The data are expressed in categorical variables in absolute numbers and percentages. Results: A total of 21 patients were included. Median age was 46 years (range, 24 - 83). The mean hemoglobin level was 7.6 g/dl. In our study, 95.2% of the patients responded to the first embolization, and 28.5% required a second intervention throughout the oncological treatment, and only one patient (4.76%) needed a third embolization. Regarding the material used, 66.6% of the patients were embolized with a gelatin sponge, while definitive material was used in the remaining patients (33.3%). Patients who underwent a second embolization, gelatin sponge was used in 83.33% and definitive material was used in only 1 (16.66%). The average survival time from diagnosis was 17.8 months, while the time from the first embolization was 9.8 months. 47.6% of the patients died after the first or second episode of embolization. 95.2% of the patients did not present complications and only 1 (4.76%) died two days after the procedure. Conclusion: Uterine artery embolization is a safe and effective procedure for the treatment of acute hemorrhage in patients with advanced cervical cancer. However, since it is a procedure that is performed only in tertiary centers, it makes it difficult to have universal access.