Long-Term Results of Surgical Management of Pulmonary Metastases from Renal Cell Carcinoma

Abstract

Background: Metastatic renal cell carcinoma (RCC) has a poor prognosis and conventional treatments such as chemoradiotherapy show little efficacy. Surgical resection of pulmonary metastases from RCC is a widely accepted treatment, even if selection criteria based on prognostic factors have still not been defined. The aim of this study was to determine the long-term survival, clinical outcome and prognostic factors after surgery. Methods: Between 1988 and 2004, 59 patients underwent resection of pulmonary metastases from RCC. Univariate and multivariate analysis of prognostic factors was carried out. Results: Complete resection was achieved in 54 (91.5 %) patients. No intra- or postoperative mortality occurred, 5 (8.5 %) patients experienced postoperative complications. Overall, the 1-, 3-, and 5-year survival rates were 86.5 %, 63 % and 53 %, respectively. Age at the time of pulmonary resection was found to be the only independent factor influencing prognosis. Conclusion: Pulmonary resection of metastases from RCC is a safe and effective treatment associated with a low morbidity and mortality and with high long-term survival. The lack of other effective therapies suggests use of the surgical approach whenever possible.

Key words

Renal cell carcinoma - pulmonary metastases - nephrectomy - surgical resection

References

• 1 Boring C C, Squires T S, Tong T. Cancer statistics, 1991.  Cancer. 1991;  41 19-36
• 2 Parkin D M, Pisani P, Ferlay J. Estimates of the worldwide incidence of eighteen major cancers in 1985.  Int J Cancer. 1993;  54 594-606
• 3 McCredie M. Bladder and kidney cancers.  Cancer Surv. 1994;  19 343-368
• 4 Motzer R J, Bander N H, Nanus D M. Renal-cell carcinoma.  N Engl J Med. 1996;  335 865-875
• 5 Dresler C M. Kidney metastases. Metastatic disease to the lung.  Chest Surg Clin North Am. 1998;  8 127-129
• 6 Friedel G, Hurtgen M, Penzenstadler M, Kyriss T, Toomes H. Resection of pulmonary metastases from renal cell carcinoma.  Anticancer Res. 1999;  19 1593-1596
• 7 Yagoda A, Petrylak D, Thompson S. Cytotoxic chemotherapy for advanced renal cell carcinoma.  Urol Clin North Am. 1993;  20 303-321
• 8 Harris D T. Hormonal therapy and chemotherapy of renal cell carcinoma.  Semin Oncol. 1983;  10 422-430
• 9 De Mulder P H, Oosterhof G, Bouffioux C, van Oosterom A T, Vermeylen K, Sylvester R. EORTC (30885) randomised phase III study with recombinant interferon alpha and recombinant interferon alpha and gamma in patients with advanced renal cell carcinoma. The EORTC Genitourinary Group.  Br J Cancer. 1995;  71 371-375
• 10 Fisher R I, Rosenberg S A, Fyfe G. Long-term survival update for high-dose recombinant interleukin-2 in patients with renal cell carcinoma.  Cancer J Sci Am. 2000;  6 S55-S57
• 11 Childs R, Chernoff A, Contentin N. et al . Regression of metastatic renal cell carcinoma after nonmyeloablative allogeneic peripheral-blood stem-cell transplantation.  N Engl J Med. 2000;  343 750-758
• 12 Barney J D, Churchill E J. Adenocarcinoma of the kidney with metastasis to the lung.  J Urol. 1939;  42 269-276
• 13 Pastorino U. Lung metastasectomy: why, when, how.  Crit Rev Oncol Hematol. 1997;  26 137-145
• 14 Putnam J B. Secondary tumors of the lung. Shields TW General Thoracic Surgery. Philadelphia; Lippincott, Williams & Wilkins 2004: 1831-1862
• 15 Greene F L, Page D, Fleming I D. et al .AJCC Cancer Staging Manual (6th ed.). New York; Springer 2002: 323-328
• 16 Pastorino U, Buyse M, Friedel G. et al . Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. The international registry of lung metastases.  J Thorac Cardiovasc Surg. 1997;  113 37-49
• 17 Cerfolio R J, Allen M S, Deschamps C. et al . Pulmonary resection of metastatic renal cell carcinoma.  Ann Thorac Surg. 1994;  57 339-344
• 18 Pfannschmidt J, Hoffmann H, Muley T, Krysa S, Trainer C, Dienemann H. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma.  Ann Thorac Surg. 2002;  74 1653-1657
• 19 Piltz S, Meimarakis G, Wichmann M W, Hatz R, Schildberg F W, Fuerst H. Long-term results after pulmonary resection of renal cell carcinoma metastases.  Ann Thorac Surg. 2002;  73 1082-1087
• 20 Kavolius J P, Mastorakos D P, Pavlovich C, Russo P, Burt M E, Brady M S. Resection of metastatic renal cell carcinoma.  J Clin Oncol. 1998;  16 2261-2266
• 21 McCormack P M, Bains M S, Begg C B. et al . Role of video-assisted thoracic surgery in the treatment of pulmonary metastases: results of a prospective trial.  Ann Thorac Surg. 1996;  62 213-217
• 22 Pogrebniak H W, Haas G, Linehan M, Rosenberg S A, Pass H I. Renal cell carcinoma: resection of solitary and multiple metastases.  Ann Thorac Surg. 1992;  54 33-38
• 23 Fourquier P, Regnard J F, Rea S, Levi J F, Levasseur P. Lung metastases of renal cell carcinoma: results of surgical resection.  Eur J Cardiothorac Surg. 1997;  11 17-21