This new 1318-nm Nd:YAG laser facilitates complete resection of multiple bilateral centrally located metastases and thus is lobe sparing. Resection of 20 or more metastases is reasonable because long-term survival was significantly better than that observed with incomplete resection.

Our understanding of metastatic spread is limited and molecular mechanisms causing particular characteristics of metastasis are largely unknown. Herein, transcriptome-wide expression profiles of a unique cohort of 20 laser-resected pulmonary metastases (Mets) of 18 patients with clear-cell renal cell carcinoma (RCC) were analyzed to identify expression patterns associated with two important prognostic factors in RCC: the disease-free interval (DFI) after nephrectomy and the number of Mets per patient. Differentially expressed genes were identified by comparing early (DFI 9 months) and late (DFI 5 years) Mets, and Mets derived from patients with few ( 8) and multiple ( 16) Mets. Early and late Mets could be separated by the expression of genes involved in metastasis-associated processes, such as angiogenesis, cell migration and adhesion (e.g., PECAM1, KDR). Samples from patients with multiple Mets showed an elevated expression of genes associated with cell division and cell cycle (e.g., PBK, BIRC5, PTTG1) which indicates that a high number of Mets might result from an increased growth potential. Minimal sets of genes for the prediction of the DFI and the number of Mets per patient were identified. Microarray results were confirmed by quantitative PCR by including nine further pulmonary Mets of RCC. In summary, we showed that subgroups of Mets are distinguishable based on their expression profiles, which reflect the DFI and the number of Mets of a patient. To what extent the identified molecular factors contribute to the development of these characteristics of metastatic spread needs to be analyzed in further studies. ' UICC Key words: kidney cancer; lung metastases; oligonucleotide microarraysIn numerous tumour types, the development of metastases (Mets) causes the patients' death. The median survival of renal cell carcinoma (RCC) patients amounts to merely 6 to 12 months after Mets have been diagnosed. 1 RCC is the urological cancer with the highest percentage of tumour-related deaths 2 because metastasis occurs in about 60% of the patients. 3 The preferential localization of RCC Mets is the lung. 1 In contrast to the emerging development of molecular-based therapies for RCC in the last few years, 3 molecular prognostic markers are still missing. Despite the knowledge of several molecular factors involved in metastatic spread like angiogenesis, cell adhesion, invasion or migration, 4,5 little is known about specific characteristics of this complex process. These are, for example, primary-dependent site-specific metastasis, 6 varying dormancy periods of Mets originating from the same primary tumour entity causing disease-free intervals (DFI) ranging from several months to many years, or the differing number of Mets in patients with the same primary tumour. Knowing the molecular fundamentals of these phenomena would support the prognosis of patients' outcome and facilitate the decision for an appropriate therapy regime, particularly in RCC where the DFI and the number of Mets are important predictors of clinical...

Background and Objectives: Advantages of a new 1,318 nm Nd:YAG laser based on multiple lung metastasectomies are shown. Study Design/Materials and Methods: Ninety-three percent of 328 patients with metastases (8/patient, range 1-124) had precision laser resections (lobectomy-rate reduced to 7%); this laser delivers 20 kW/cm 2 1,318 nm power densities with 400 mm fibers, and a focussing handpiece. Absorption in water is tenfold higher. Results and Conclusions: Between 1/1996 and 12/2003 in 328 patients (164 males/females, 61 years) 3,267 nodules were removed. Pathologic examination revealed 2,546 metastases (range 3-80 mm) from kidney (n ¼ 112), colorectal (n ¼ 91), and breast cancers (n ¼ 35). In 85% of patients where the complete resection was achieved the 5-year survival was 41%. For remaining 15% (incomplete resection) the 5-year survival was 7%. Five-year survival for patients with 10 (and more) metastases was 28%, for patients with 20 (and more) was 26%. No 30-day mortality was observed. Conclusion: This new laser system facilitates any kind of parenchymal lung resection in lobe-sparing manner and in case of complete resection improves significantly the survival.

If complete resection is achieved, laser resection can remove even high numbers of metastases with considerable and comparable long-term survival known from previous reports. This tissue-saving technique allows repeated resections in case of recurrence.

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