Local progression after operative treatment of metastatic kidney cancer

The cases of 78 patients with osseous metastases from kidney cancer were re viewed to determine the rate of local progression after operative resection as compared with more traditional intralesional procedures. Group I consis ted of 41 (53%) patients who were treated with intralesional procedures inv olving internal fixation with or without curettage or polymethylmethacrylat e. Of the 41 patients, additional operations were recommended for 17 (41%) of the patients who had local osseous progression. Fourteen additional proc edures including nine wide resections with reconstruction, three amputation s, and two mass excisions were done. Group II consisted of 37 (47%) patient s who were treated with marginal or wide resection with or without reconstr uction. In this group, only one patient required additional operative inter vention for local osseous progression. Median survival of patients in Group I was 20 months compared with 35 months for patients in Group II. This stu dy shows that despite shorter average survival, patients who undergo intral esional surgery are at high risk of reoperation for local progression. Rese ctional surgery should be considered in patients with skeletal metastases f rom kidney cancer to lessen the risk of reoperation for local progression.