Surgical treatment of metastases in patients with renal cell carcinoma

Abstract

The aim of the present study was to investigate the efficacy of surgical excision of metastases in patients with renal cell carcinoma (RCC). Eighteen patients with metastatic RCC underwent resection of metastases between 1988 and 1994 (pulmonary: n = 6; skeletal: n = 6; cerebral: n = 3; local relapse: n = 3). Two patients suffered from synchronous appearance of metastases, whereas in 16 cases a metachronous occurrence was observed. In 12 out of a total of 18 patients metastases were completely resected. These patients survived longer than patients in whom metastases were incompletely resected (30 vs. 12 months). Six out of these 12 patients with a complete resection of metastases are presently free of disease for a mean duration of 24 months (10-34 months). The resection of lung metastases seems to be associated with longer survival times. In conclusion, surgical resection of metastases--solitary or single organ site--especially in the lung appears to be justified in patients with RCC. The surgical excision of skeletal metastases at least improves quality of life.

Treatment and survival of osseous renal cell carcinoma metastases

“…Patients with solitary lesions had a disease‐free survival that is comparable to patients presenting with several skeletal lesions. Studies have reported improved survival with wide resection of solitary osseous metastases with minimal or no local progression 25, 5, 7, 13, 26–30, whereas another study, like ours, found no effect on overall survival 31. The differences between these observations are likely related to patient selection bias and study design flaws inherent in retrospective studies.…”

“…Controversy remains concerning appropriate treatment of osseous metastatic renal cell carcinoma (Table III). Some studies have shown wide resection to be a positive prognostic indicator of improved survival 7; however, several others were unable to confirm these data 20, 5, 13. Some studies have demonstrated intralesional procedures have a high failure rate (5–40%) resulting in the need for further surgical interventions compared with patients undergoing wide resection 5, 21, 7, 22, 12, 23.…”

“…Patient selection for different methods of resection and reconstruction has not been well defined. Furthermore, aggressive surgical intervention has been questioned because of the poor prognosis in affected patients 5, 13. A recent study by Lin et al 14 identified several predictors of survival including metastases confined to bone and solitary osseous lesions but was unable to make any meaningful conclusions comparing en bloc resection to intralesional procedures.…”