Ces Urol 2014, 18(2):112-118 | DOI: 10.48095/cccu2014023

The role of pulmonary metastasectomy in the treatment of disseminated clear renal cell carcinoma

Josef Vodička¹, Vladimír Špidlen¹, Jakub Fichtl¹, Petr Mukenšnabl², Lucie Šefrhansová³, Milena Roušarová⁴, Milan Hora⁵

¹ Chirurgická klinika LF UK, Plzeň

² Šiklův patologicko-anatomický ústav LF UK, Plzeň

³ Onkologická a radioterapeutická klinika LF UK, Plzeň

⁴ Národní onkologický registr FN, Plzeň

⁵ Urologická klinika LF UK, Plzeň

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 metas-tases 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 met-astatectomy 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. Tong-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 RO resection.

Keywords: metastasectomy, pulmonary metastases, clear renal cell carcinoma

Received: December 20, 2013; Accepted: February 12, 2014; Published: March 1, 2014