Aggressive Versus Conservative Management of Stage IV Renal Cell Carcinoma

Klugo, Richard C.; Detmers, Michael; Stiles, Richard E.; Talley, Robert W.; Cerny, Joseph C.

doi:10.1016/s0022-5347(17)57959-8

Cited by 135 publications

(43 citation statements)

References 19 publications

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“…These factors may help us to select patients for whom nephrectomy may be beneficial. Many prognos tic factors such as performance status [9][10][11], tumor size [3], tumor grade [11], gender [12,13] and site or number The group with métastasés to multiple organs had the poorest prognosis (p = 0.015; group with single metastatic focus in a single organ vs. group with multiple-organ métastasés.…”

Section: Discussionmentioning

confidence: 99%

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

Miyao

Oda²,

Shigyou³

et al. 1997

Eur Urol

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Section: Discussionmentioning

confidence: 99%

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

Miyao

Oda²,

Shigyou³

et al. 1997

Eur Urol

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“…Therefore most authors are in favour of nephrectomy [11,13,18,19], especially if there is only a single metastasis [7,17,18]. Garfield [13] defines the role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma as follows:…”

Section: Discussionmentioning

confidence: 99%

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

Riese

Goldenberg

Allhoff

et al. 1991

International Urology and Nephrology

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We report 4 cases of metastatic renal cell carcinoma (RCC) with long-term survival either following radical nephrectomy alone or in combination with radioor hormonal therapy.Two patients with lymph node metastases showed a long-term survival of 12 or more years following radical tumour nephrectomy (with lymphadenectomy) and radiotherapy. One of them exhibited a histologically proven tumour recurrence nearly 12 years after pIimary surgical treatment and died shortly later; the other one is still without any evidence of metastatic disease.Two other patients exhibited spontaneous regression of pulmonary metastases: one regression occurred after radical tumour nephrectomy alone, the other one after successful primary hormonal treatment and subsequent radical tumour nephrectomy.The following important aspects are emphasized: 1. Renal cell carcinoma is a very unpredictable tumour. Once the diagnosis of renal cell carcinoma is proved, a patient can never be considered cured.2. Although adjuvant palliative nephrectomy has produced contradictory results in several reports, radical tumour nephrectomy either alone or in combination with other adjuvant therapies such as radiotherapy, hormonal or immunological treatment, can be worthwhile. Cases with long-term survival and spontaneous regression of distant metastases are proof of this. Besides, if carefully selected, the mortality rate of different adjuvant therapies is not significantly higher in patients with metastatic disease than in patients without metastases.The world literature on this subject is reviewed.

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“…Sites of tumor metastases and recurrence include the lungs, bone, skin, liver, and locally, whereas metastases to the GI tract and pancreas are relatively rare. The incidence of PMs is reportedly around 2.8% in clinical cases [8] and 6% in autopsy cases [9]. In general, these tend to be hematogenous metastases, but this has not been confirmed.…”

Section: Discussionmentioning

confidence: 96%

Histopathological Aspects of Pancreatic Metastases in Renal Cell Carcinoma: Does the Mode of Invasion Permit Limited Resections?

Kimura

Keira²,

Imamura³

et al. 2014

Pancreat Disord Ther

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Purpose: To investigate histopathological characteristics, we retrospectively analyzed data from patients who underwent resection of renal cell carcinoma pancreatic metastases (RCC-PMs). Methods:This study included 34 RCC-PM lesions in 13 patients who underwent 15 pancreatic operations. The clinicopathlogical characteristics were analyzed with special emphasis on tumor capsular formation, manner of peritumoral invasion, and presence of lymphovascular invasion.Results: Median duration to onset of RCC-PMs was 101 months from initial nephrectomy. Surgical procedures included distal pancreatectomy in 6 cases, pancreaticoduodenectomy in 4, total pancreatectomy in 1, and limited resections in 6 with two overlapping procedures. No perioperative deaths were encountered. One, three, and five year survival rates after pancreatic resection were 86.2%, 86.2%, and 76.6%, respectively. Of thirty-four lesions 32 lesions with tumor diameter ≤ 35 mm were encapsulated. Of these 32 lesions with capsule formation, extra capsular invasion was identified in 5 lesions. No lymphatic invasion was identified in any case. Venous invasion was presented just adjacent to the tumors in 2 lesions. Five year survival rates for the 11 cases with standard operations and 4 cases with limited resection were 70.7% and 100%, respectively without any significant difference. Conclusions:Small RCC-PMs were frequently encapsulated, seldom invaded into pancreatic parenchyma, and were rarely accompanied by microscopic lymph vascular invasion. Limited resection of the pancreas with adequate surgical margins may be oncologically acceptable.

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Aggressive Versus Conservative Management of Stage IV Renal Cell Carcinoma

Cited by 135 publications

References 19 publications

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

Pre-Operatively Determined Prognostic Factors in Metastatic Renal Cell Carcinoma

Metastatic renal cell carcinoma (RCC): Spontaneous regression, long-term survival and late recurrence

Histopathological Aspects of Pancreatic Metastases in Renal Cell Carcinoma: Does the Mode of Invasion Permit Limited Resections?

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