Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

Abstract

BACKGROUND The therapeutic approach of metastatic renal cell carcinoma (RCC) represents a real challenge for clinicians, because of the variable clinical course; the recent availability of numerous targeted therapies that have significantly improved overall oncological results, but still with a low percentage of complete responses; and the increasing role of metastasectomy (MSX) as an effective strategy to achieve a durable cure, or at least defer initiation of systemic therapies, in selected patients and in the context of multimodality treatment strategies. CASE SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC; he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy, with subsequent systemic therapy with Fluorouracil, Interferon-alpha and Interleukin 2. The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences, successfully treated with multiple systemic treatments, repeated local treatments, including two pancreatic resections, conservative resection and ablation of multiple bilobar liver metastases, resection and stereotactic body radiotherapy of multiple lung metastases. He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites, including resection of more than 38 metastases, and 5 years after his last MSX. CONCLUSION This case highlights that effective multimodality therapeutic strategies, including multiple systemic treatments and iterative aggressive surgical resection, can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.

Lung Metastasis From Renal Cell Carcinoma 16 years After Nephrectomy: A Case Report and Review of the Literature

“…Here we report a rare case of RCC that presented with lung metastasis 16 years after nephrectomy. Based on our literature review, we found only ten reported cases with intervals longer than in our case between nephrectomy for RCC and lung metastasis: 17 years [5], 19 years [6], six cases with 20-28 years intervals [7], 31 years [8], and 37 years [9].…”

“…RCC recurs after more than 10 years of nephrectomy in 10% of the cases [11]. The most common sites of metastasis include lungs, bones, lymph nodes, adrenal glands, liver, brain contralateral kidney, and pancreas [5]. Metastatic clear cell RCC has a poor prognosis with a median overall survival of 12 months only which has improved in the last decade [12].…”

“…Disease recurrence likelihood for RCC depends on several known and unknown factors including host and tumor factors [5]. Prognostic indicators for RCC include complete resection of all metastasis, low number of metastasis, long disease-free interval between primary tumor diagnosis and lung lesions, lymph node involvement, and size of pulmonary nodule [9].…”

Lung metastasis from renal cell carcinoma 16 years after nephrectomy: A case report and review of the literature

“… 11 The most common sites of metastasis include lungs, bones, lymph nodes, adrenal glands, liver, brain, contralateral kidney, and pancreas. 5 Metastatic clear cell RCC has a poor prognosis with a median overall survival of 12 months only which has improved in the last decade. 12 Pulmonary metastasis from RCC after a long interval is rare.…”

Management of pulmonary metastases: the surgeon’s perspective

“…Is systematic lymph node dissection always required when performing lung metastasectomy, or should it be offered in selected cases only? Which patients can benefit of iterative surgical excision of secondary lung localizations and what is the expected survival benefit (13)(14)(15)(16)?…”