Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience.
ABSTRACT Despite the report of new treatment options, surgery remains the best treatment for pulmonary metastases from renal cell carcinoma (RCC). Repeat resection is also an effective means for recurrent pulmonary metastases. The aim of the present study was to define the prognostic factors for survival after pulmonary metastasectomy from RCC based on a 25-year single-centre experience.
Between 1973 and 2008, 59 thoracotomies on 48 patients (38 men, 10 women) were performed in our hospital. Repeat resections were performed in eight patients. The clinicopathological and surgical data of these patients obtained from the medical records were analysed. The time interval between lung resection and death, or latest follow-up, ranged from 3 to 177 months (median 39 months). Survival analysis was conducted by the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox multivariate proportional hazard model.
The cumulative 3-, 5- and 10-year survival rates were 60%, 47% and 18%, respectively. Multivariate analysis identified disease-free interval (DFI) (≥ 2 years) and complete resection as significant prognostic factors for survival. Among eight patients, who underwent repeat resection, two remain alive with no evidence of disease. These two patients had long DFI and long DFI-2 (time from first pulmonary metastasectomy to diagnosis of recurrent pulmonary metastasis).
The results showed that (1) surgical resection of pulmonary metastasis from RCC has a favourable outcome in selected patients, (2) DFI and completeness of resection are prognostic markers for survival after pulmonary metastasectomy and (3) repeat lung resection for metastatic RCC is a safe procedure that provides satisfactory patient outcomes.
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ABSTRACT: The purpose of this study is to identify factors associated with time-related survival after pulmonary metastasectomy for renal cell carcinoma and to confirm the safety of metastasectomy. From January 1986 to July 2001, 417 patients were diagnosed with pulmonary metastases from renal cell carcinoma; 92 underwent pulmonary metastasectomy. Median disease-free interval after nephrectomy was 3.0 years. Half the patients had 1 or 2 pulmonary nodules; 37% had 5 or more. Median size of the largest nodule (pulmonary metastasis) was 15 mm. Complete resection was obtained in 63 patients (68%). Twenty-nine patients received preoperative immunotherapy. Multivariable hazard function analysis was used to identify continuous, ordinal, and true dichotomous risk factors. Predictors: The strongest risk factor for time-related mortality was incomplete resection. Five-year survival was 8% for incomplete and 45% for complete resection. Other risk factors included the following continuous and ordinal variables: larger nodule size (p = 0.0001), increasing number of involved lymph nodes (p = 0.01), and decreased preoperative 1-second forced expiratory volume (p = 0.02). Immunotherapy did not improve survival. For completely resected patients, shorter disease-free interval was a risk factor (p = 0.01). Fewer pulmonary nodules predicted higher probability of complete resection (p < 0.0001). Safety: No operative deaths occurred. Nine patients (10%) experienced a total of 12 complications, with persistent air leak and atrial arrhythmia accounting for 5 (42%). Because pulmonary metastasectomy for renal cell carcinoma is safe, survival depends on complete resection of pulmonary disease and adequate pulmonary reserve. Preoperative determination of resectability is thus critical, and computed chest tomography and mediastinoscopy are valuable tools for optimizing patient selection.The Annals of thoracic surgery 04/2005; 79(3):996-1003. · 3.74 Impact Factor
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ABSTRACT: Pulmonary resection for metastatic disease in 167 patients undergoing 207 thoracotomies resulted in a cumulative survival rate of 29% at five years and 20% at 10 years, with an operative mortality of 0.6%. The most favorable prognosis was associated with testicular and renal cell carcinomas and sarcomas. Less favorable tumors were malignant melanoma, carcinoma of the colon and rectum, and cervix uteri. A significant factor influencing survival was duration of disease-free interval with a 50% five-year survival rate in patients whose primary tumor was treated over five year ago. Patients with multiple pulmonary metastases had a five-year survival rate of 27% vs. 22% of patients with solitary metastases. Of 23 patients with tumor extending to the chest wall, diaphragm, or pleura, only two survived five years. Of 26 patients with mediastinal involvement none survived two years.Cancer 07/1980; 45(12):2981-5. · 5.20 Impact Factor
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ABSTRACT: Thirty-three patients operated on for pulmonary metastases from renal cancer were followed up for a minimum of 5 years or to death. The 5-year survival was 21%. There was a tendency to better survival in patients operated by lobectomy rather than limited resection. Extended operations carried a grave prognosis. Manifest metastatic disease within one year after the primary operation showed shortened survival. Repeated operations were possible, with good results. It is concluded that operations for pulmonary metastases can be performed with good results. However, the effect is a palliative one as the ultimate cause of death in all instances was the spread of the cancer disease.Scandinavian Journal of Urology and Nephrology 02/1985; 19(2):133-7. · 1.01 Impact Factor