Metastatic renal cell carcinoma of the spine: surgical treatment and results

Object. Renal cell carcinoma (RCC) is an aggressive malignancy that frequen tly metastasizes. When RCC metastasizes to the spine, significant pain and neurological dysfunction often follow. Because systemic therapy and radioth erapy have a limited effect in controlling spinal disease, surgery is frequ ently required; however, there are very few published series specifically a ddressing the role and benefits of the surgical treatment for this disease. The authors conducted a retrospective study to review their experience wit h the surgical treatment of metastatic RCC of the spine, paying particular attention to methodology and patient neurological status, pain relief, and survival. Methods. Between January 1993 and April 1999, 79 patients (63 men and 16 wo men patients; average age 55 years, range 16-82 years) underwent 107 spinal operations for metastatic RCC. indications for surgery included disabling pain (94 [88%] of 107 procedures) and/or neurological dysfunction (55 [51%] of 107 procedures). The anatomical location and extent of tumor determined the choice of an anterior, posterior, or combined surgical approach. Inter nal fixation was per formed in all but three patients. Preoperative emboliz ation was required in approximately one half of the patients. Radiotherapy was performed in 40 patients prior to surgery, and immuno- and chemotherapy were administered in 70 patients either pre- or postoperatively. After an average follow-up duration of 15 months, 57 patients had died. Kaplan-Meier analysis revealed a median postoperative survival of 12.3 months. Signific ant pain reduction, as indicated by a. visual analog pain scale, was achiev ed in 84 (89%) of the 94 cases presenting with disabling pain. Neurological improvement was seen in 36 (65%) of the 55 patients. The major morbidity a nd 30-day mortality rates were 15% (16 of 107 procedures) and 2% two of 107 procedures), respectively. Conclusions. In selected patients with metastatic RCC of the spine, resecti on followed by stabilization can provide pain relief and neurological prese rvation or improvement.