PULMONARY RESECTION OF METASTATIC RENAL-CELL CARCINOMA

Between 1965 and 1989, 96 consecutive patients (64 men and 32 women) u nderwent complete pulmonary resection for metastatic renal cell carcin oma. Median age was 63 years (range, 33 to 82 years). Median time betw een nephrectomy and pulmonary resection was 3.4 years (range, 0 to 18. 4 years). Forty-eight patients had solitary metastasis, 16 had two, 18 had three, and 14 had more than three. Wedge excision was performed i n 62 patients, segmentectomy in 3, lobectomy in 25, bilobectomy in 3, and pneumonectomy in 3. Fourteen patients had repeat thoracotomy for r ecurrent metastasis; 34 other patients also had complete resection of limited extrapulmonary disease. There were no operative deaths. Median follow-up was 3 years (range, 70 days to 19.0 years). Overall 5-year survival was 35.9%. Patients with solitary metastasis had a 5-year sur vival of 45.6% compared with 27.0% for patients with multiple metastas es (p < 0.05). Patients with a tumor-free interval greater than the me dian of 3.4 years had a better survival (p = 0.05) than those with a t umor-free interval less than or equal to 3.4 years. Five-year survival for patients who underwent repeat thoracotomy or had complete resecti on of extrapulmonary disease did not differ from overall survival. We conclude that resection of renal lung metastasis is safe and effective , that patients with solitary metastasis have a better survival than t hose with multiple metastases, that resectable extrapulmonary disease does not necessarily contraindicate pulmonary resection, and that repe at thoracotomy is warranted in selected patients with recurrent lung m etastases.