SURGEONS ROLE IN THE MANAGEMENT OF SOLITARY RENAL-CELL CARCINOMA METASTASES OCCURRING SUBSEQUENT TO INITIAL CURATIVE NEPHRECTOMY - AN INSTITUTIONAL REVIEW

Background: Solitary metastases from a primary renal cell carcinoma (R CC) occur in <10% of patients with metastatic RCC. To date, the benefi t of surgically resecting such apparently solitary lesions has not bee n well documented. Materials and Methods: Forty-one patients (25 men, 16 women) with metastatic renal cell carcinoma treated by surgical exc ision of solitary metastases (1970-1990) were retrospectively reviewed . They comprised 9% of patients with metastatic hypernephroma seen dur ing this period. All patients had undergone previous curative nephrect omy with a median disease-free interval of 27 months. Patients with sk eletal, spinal cord, and lymph node metastases were excluded. Results: Metastases were intrathoracic (n = 20), intracranial (n = 7), and int raabdominal or in the extrapleural chest wall soft tissue (n = 10). Th ree patients had metastases to the thyroid gland and one had a solitar y metastasis to an index finger. Median follow-up was 3.2 years. Compl ete resection was possible in 36 patients (88%) with a single lesion e xcised in 23 of these 36 patients (64%). There was no operative mortal ity. Predicted survival from the date of complete resection of metasta ses was 77%, 59%, and 31% at 1, 3, and 5 years, respectively. with a m edian survival of 3.4 years. One patient is alive without evidence of recurrent tumor 93 months from the first of 12 complete surgical resec tions. Varying adjuvant therapy was used in 50% of the patients. An in creased histological tumor grade of the metastatic lesion relative to the original RCC was the only significant prognostic indicator identif ied. Disease-free interval and number of resected lesions were not sig nificantly associated with patient survival Conclusion: A small fracti on of renal cell carcinoma patients are candidates for potentially cur ative surgical resection of solitary metastatic lesions. Excision of s uch lesions may contribute to prolonged survival in selected instances .