The role of pulmonary metastasectomy in the treatment of disseminated clear renal cell carcinoma
Authors:
Josef Vodička 1; Vladimír Špidlen 1; Jakub Fichtl 1; Petr Mukenšnabl 2; Lucie Šefrhansová 3; Milena Roušarová 4; Milan Hora 5
Authors‘ workplace:
Chirurgická klinika LF UK, Plzeň
1; Šiklův patologicko-anatomický ústav LF UK, Plzeň
2; Onkologická a radioterapeutická klinika LF UK, Plzeň
3; Národní onkologický registr FN, Plzeň
4; Urologická klinika LF UK, Plzeň
5
Published in:
Ces Urol 2014; 18(2): 112-118
Category:
Original article
Overview
Introduction:
At the time of diagnosis, up to one third of patients with clear renal cell carcinoma have a disseminated disease, and half of patients with the localized disease will progress in the future. Dissemination into the lungs develops most frequently.
Purpose:
Retrospective analysis of a group of patients undergoing surgery due to pulmonary metastases of clear renal cell carcinoma over a period of twelve years.
Material and methods:
Between 2001 and 2012, 21 patients, including 14 males, with a mean age of 65.7 years, underwent surgery at the authors’ department. Those patients who had undergone a radical resection for renal cell carcinoma, who had no extra-pulmonary metastases, and whose pulmonary metastases appeared to be radically removable according to pre-operative assessments, were indicated for the pulmonary metastatectomy. Solitary metastases were found in 11 patients, multiple metastases in the remaining patients. Four patients had bilateral metastases. The medial of the symptom-free period since nephrectomy was 24 months.
Results:
A total of 17 unilateral and 4 bilateral surgeries were performed. The most common type of surgery included wedge pulmonary resections (12 procedures). A total of 43 metastases were radically resected. Perioperative morbidity was 9.5% with zero mortality. At the time of publication, 57.1% of those that underwent a metastasectomy were alive, with a with median survival time of 44.3 months. Three-year and five-year survival rates in the group were 57% and 49%, respectively. Nine patients (42.9%) are alive after the metastasectomy without disease progression; the median was 24 months.
Conclusion:
The presented results confirm the positive role of metastasectomy in the treatment of pulmonary metastases of clear renal cell carcinoma. Long-term survival following pulmonary metastasectomy can be expected in solitary, metachronic metastases of a small size with a disease free interval > 1 year following nephrectomy, with the absence of metastases in the regional lymphatic nodes and R0 resection.
Key words:
metastasectomy, pulmonary metastases, clear renal cell carcinoma.
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
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