Metastasectomy in Renal Cell Carcinoma

Hong, Chang Hee; Chung, Byung Ha; Hong, Sung Joon

Abstract

PURPOSE: We reviewed clinical feature and survival rates of metastatic renal cell carcinoma(RCCa) and analyzed the prognostic factors and surgical outcomes in patients who underwent surgical resection of metastatic RCCa.
MATERIALS AND METHODS
Among 287 patients who underwent radical nephrectomy for RCCa from January 1990 to June 1997, 65 patients had metastatic disease. In 31 patients, metastatic lesions were surgically removed. Survival rates were analyzed according to various prognostic factors(the completeness of metastasectomy, synchronicity or metachronicity of metastasis, interval to metastasis after radical nephrectomy, Fuhrman`s grade of metastatic lesions and interval to the development of a new metastatic lesion after metastasectomy)
RESULTS
The metastasectomy was complete in 18 and incomplete in 13, and 3-year survival rates were 59% and 8%, respectively(p=0.0013). In the group of patients who underwent complete resection of metastatic lesion, time to recurrence was significantly influential on survival with 3 year survival rate of 100% and 15% for those whose disease recurred after and before 12 months, respectively(p=0.001). For those who underwent curative resection of the metastatic lesion, synchronicity or metachronicity of metastasis, time to metastasis and Fuhrman`s grade did not influence survival after complete resection (p=0.675, p=0.607 and p=0.074).
CONCLUSIONS
Aggressive surgical treatment should be considered in selected cases in whom complete resection of the metastatic lesion is feasible for the purpose of long term survival. If no newly developed lesion is found within 1 year after operation, favorable prognosis could be expected.