Objective: In 60-70% of patients with renal cell carcinoma (RCC), metastase
s develop in the course of the disease. In the present analysis, the surgic
al management of metastases is described, and survival data are presented.
This retrospective analysis may help in the management of future cases. Due
to the retrospective nature of the data, no comparison between surgical an
d nonsurgical management is possible. Methods: Between 1985 and 1995, 152 r
esections of RCC metastases were performed in 101 patients at four Dutch Ho
spitals. Thirty-five and 6 patients had metastases resected 2 and 3 times,
respectively. In most patients, the primary tumor was resected (n = 95). Re
sections were performed for metastases at different locations: lung n = 54,
bone n = 42, lymph nodes n = 18, cerebrum n = 12 and locations in the spin
al canal, thyroid, bowel, and testis. Skin excisions were excluded from the
analysis. Solitary metastases were resected in 40 patients. Results: Media
n survival after the initial metastasectomy was 28 months. Initial tumor st
age, grade, or size were not related to metastasis location or survival. Th
e number of initially resected pulmonary metastases was of no influence on
survival, however, multiple consecutive resections were related with longer
survival. Patients with solitary metastases (n = 40) did not show longer s
urvival after the first metastasectomy compared to no solitary lesions. Bet
ter survival was found for lung metastases compared to other tumor location
s (p = 0.0006, log rank test) and for patients that were clinically tumor f
ree after metastasectomy (p = 0.0230, log rank test). Additional immuno- or
radiotherapy did not independently influence survival. Time interval betwe
en primary tumor resection and metastasectomy correlated positively with su
rvival: a tumor-free interval of more than 2 years between primary tumor an
d metastasis was accompanied by a longer disease-specific survival after me
tastasectomy. Eleven patients were free of disease after metastasectomy wit
h a median time of 47 (14-65) months. The median time of hospital admittanc
e for metastasectomy was 9 days (464). Lethal complications were found in 2
patients. Longterm (>5 years) disease-free survival was achieved in 7% of
patients whereas 14% of patients were free of disease with a minimal follow
-up of 45 months. Conclusions: (1) Surgical management of metastases could
be performed with short hospital stay, and low complication rates were foun
d. (2) Disease-free survival was found in 14 and 7%, with follow-ups of at
least 45 and 60 months, respectively. (3) The longest survival was found af
ter surgery for pulmonary lesions. (4) Resection of solitary metastases did
not result in longer survival compared to resection of nonsolitary lesions
. (5) An interval shorter than 2 years between primary tumor and metastases
was correlated with a shorter disease-specific survival.