Liver resection for metastases from renal cell carcinoma.
ABSTRACT This study was conducted to evaluate the safety and efficacy of liver resection in patients with hepatic metastases from renal cell carcinoma and to identify selection criteria for patients suitable for resection.
Between January 1988 and March 2006, 31 patients underwent liver resection for metastases from renal cell carcinoma. Patients were identified from a prospective database and retrospectively reviewed. Patient, tumor, and operative parameters were analyzed for their influence on long-term survival.
The overall 1-, 3- and 5-year survival rates were 82.2%, 54.3%, and 38.9%, respectively. One patient was deceased and 4 developed complications during the postoperative course. In the univariate analysis, site of the primary tumor (P = 0.013), disease-free interval (P = 0.012), and resection margins (P = 0.008) showed significant influence on long-term survival. In the multivariate analysis, only the resection margins were identified as an independent prognostic factor after liver resection.
Liver resection is effective and safe in the treatment of patients with hepatic metastases from renal cell carcinoma and offers the chance of long-term survival and cure. Achieving a margin-negative resection is the most important criterion in the selection of suitable patients for liver resection. However, the number of patients in the present study was small, and investigations of larger series may provide further prognostic parameters in these patients.
- SourceAvailable from: sciencedirect.comEJC Supplements 09/2013; 11(2):192–203. · 2.71 Impact Factor
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ABSTRACT: Urological malignancies represent approximately 40 % of all solid tumors. Synchronous or metachronous organ metastases develop in 30 % of patients. Depending on the tumor entity and tumor characteristics, resection of metastases can improve patient survival. Surgical resection of residual tumors is an integral part of the multimodal therapy concept of patients with nonseminomatous metastatic germ-cell cancer. Surgical inoperability is the only reason not to resect. Resection of hematogenous metastases from renal cell carcinoma has been postulated as a standard therapy for decades. Appropriate patient selection is the key for a survival benefit. Prognosticators such as patient's general condition as well as number, location, and size of metastases help to counsel and select patients accordingly. Metastases of transitional cell or penile carcinoma should only be resected when a response to systemic treatment is evident in the individual case. There is no evidence in favor of resecting organ-metastases of prostate cancer in the current guidelines and the literature. In this article, arguments against resection of metastases following the current literature and guidelines are described.Der Urologe 05/2014; · 0.46 Impact Factor
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ABSTRACT: The term 'oligometastases' was formulated to describe an intermediate state between widespread metastases and locally confined disease. The standard of care in metastatic renal cell carcinoma is systemic therapy; however, in patients with solitary or limited metastases, aggressive local therapies may potentially prolong survival. The literature suggests a survival benefit with surgical metastasectomy, with a reported 5-year survival as high as 45% in those who achieve complete resection. More recently, an expanding body of evidence supports the role of stereotactic ablative body radiation therapy for the treatment of oligometastatic renal cell carcinoma and early results demonstrate comparable local control rates with surgery. There is also increasing interest in the abscopal and immunologic effects of localized radiation. With the proliferation of newer targeted agents and immunomodulatory agents, current work is addressing the optimization of patient selection and avenues towards sequencing and combining the various treatment options.Future Oncology 04/2014; 10(5):761-74. · 3.20 Impact Factor