Metastasectomy in renal cell carcinoma: A multicenter retrospective analysis

Citation
Hg. Van Der Poel et al., Metastasectomy in renal cell carcinoma: A multicenter retrospective analysis, EUR UROL, 35(3), 1999, pp. 197-203
Citations number
15
Categorie Soggetti
Urology & Nephrology
Journal title
EUROPEAN UROLOGY
ISSN journal
03022838 → ACNP
Volume
35
Issue
3
Year of publication
1999
Pages
197 - 203
Database
ISI
SICI code
0302-2838(199903)35:3<197:MIRCCA>2.0.ZU;2-9
Abstract
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.