Pulmonary Metastases of the Clear Cell (Conventional) Renal Cell Carcinoma – Options and Results of Surgical Treatment

Czech version

Authors: J. Vodička ¹; V. Špidlen ¹; V. Šimánek ¹; J. Šafránek ¹; J. Fichtl ¹; P. Mukenšnabl ²; J. Fínek ³; M. Roušarová ⁴
Authors‘ workplace: Chirurgická klinika, LF UK a FN v Plzni ¹; Šiklův patologicko-anatomický ústav, LF UK a FN v Plzni ²; Onkologické a radioterapeutické oddělení, FN v Plzni ³; Národní onkologický registr, FN v Plzni ⁴
Published in: Klin Onkol 2011; 24(4): 293-297
Category: Original Articles

Overview

Backgrounds:
At the diagnosis, up to one third of patients with clear cell (conventional) renal cell carcinoma have metastases, and the disease will progress in a half of patients with localized disease; the lungs are the most frequently affected organ. Despite clear advances in targeted biological treatment, radical surgery of organ, mainly pulmonary, metastases is a justified treatment approach with good results.

Aim:
A nine-year retrospective analysis of patients with clear cell renal cell carcinoma undergoing surgical treatment of pulmonary metastases.

Materials and Methods:
At our centre, 13 patients with the mean age of 65 years, 9 of which were men, underwent surgical treatment between 2001 and 2009. Surgery was only indicated in patients after renal tumour resection without extrapulmonary metastases in whom presurgical assessment suggested that the pulmonary metastases were resectable (with respect to their number and location) and in whom the benefits of performing the surgery outweighed any potential risks. Metastases were solitary in 9 patients and multiple in the rest, 2 patients had bilateral involvement. Median disease-free interval following nephrectomy was 28 months.

Results:
A total of 11 unilateral and 2 bilateral resections were performed during one or two surgical operations. Most frequently, wedge resection was performed (7 patients). A total of 23 metastases were resected. Perisurgical morbidity was 15.4%, zero mortality. Of those undergoing metastasectomy, 53.8% are still surviving with a median survival of 24.3 months. Three-year survival in the sample was 66%, 5-year survival was 53%. Five patients (38.5%) have had no disease progression for a median of 8.8 months.

Conclusion:
Our results confirm the positive role of metastasectomy in the treatment of pulmonary metastases of clear cell (conventional) renal cell carcinoma. Long-term survival after pulmonary metastasectomy might be expected in patients with solitary metachrone small metastases with DFI after nephrectomy > 1 year, without tumour involvement of the relevant lymph nodes and R0 resection.

Key words:
clear cell renal cell carcinoma – metastasis – lung – metastasectomy

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