Elsevier

The Annals of Thoracic Surgery

Volume 74, Issue 5, November 2002, Pages 1653-1657
The Annals of Thoracic Surgery

Original article: general thoracic
Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma

https://doi.org/10.1016/S0003-4975(02)03803-1Get rights and content

Abstract

Background. Pulmonary resection in metastatic renal cell carcinoma is an accepted method of treatment. The purpose of this study was to determine the clinical course, outcome, and prognostic factors after surgery.

Methods. Between 1985 and 1999, 191 patients (145 men, 46 women) with pulmonary metastases from a renal cell carcinoma underwent surgical resection. Inclusion criteria for the study were the absence of primary tumor recurrence and other extrapulmonary metastases. Complete resection (CR) was achieved in 149 patients.

Results. The overall 5-year survival rate was 36.9%. The 5-year survival rate after complete metastasectomy and incomplete resection was 41.5% and 22.1%, respectively. In patients with pulmonary or mediastinal lymph node metastases, we observed after complete resection a 5-year survival rate of 24.4%, whereas the rate was 42.1% in patients without lymph node involvement. A significantly longer survival was observed for patients with fewer than seven pulmonary metastases compared with patients with more than seven metastases (46.8% vs 14.5%). For surgically rendered complete resection (CR) patients with a disease-free interval of 0 to 23 months, the 5-year survival rate was 24.7% compared with 47% for those with more than a 23-month disease-free interval. By multivariate analyses, we showed that the number of pulmonary metastases, the involvement of lymph node metastases, and the length of the disease-free interval were all predictors of survival after complete resection.

Conclusions. We conclude that pulmonary resection in metastatic renal cell carcinoma is a safe and effective treatment that offers improved survival benefit. Prognosis-related criteria are identified that support patient selection for surgery.

Section snippets

Material and methods

From January 1985 to December 1999, 191 patients at our institution with metastatic renal cell carcinoma underwent resection of pulmonary metastases. In all patients, the primary tumor was treated by radical nephrectomy; TNM classification an extend of the tumor less than 4 and showed no extrapulmonary metastatic disease. Patients with a history of renal cell carcinoma and one or more pulmonary nodules were evaluated by physical examination, chest roentgenograms, chest computed tomography (CT)

Results

The 30-day mortality rate was 2.1% (4/191 patients). The causes of death were pulmonary embolism in 2 patients and postoperative hemorrhage in 1 patient. Another patient developed a spontaneous esophageal rupture on the 12th postoperative day and died 29 days after surgery of multi-organ failure.

The follow-up period ranged from 0.1 to 157.8 months, with a median of 21.4 months. Cumulative 5-year survival rate of all patients was 36.9%. Of the prognostic factors analyzed, age, gender, and

Comment

The present study was conducted to describe criteria for selecting patients with isolated pulmonary metastases in an attempt to identify patients who would benefit from surgical resection. In a multivariate analysis of a series of 248 thoracic surgical procedures in 191 patients, the results suggest that a complete surgical resection, disease-free interval, number of metastases, and the presence or absence of thoracic lymph node metastases are all independent significant prognostic factors for

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