Metastasectomy for RCC: Rationale and outcomes

This article centers around the rationale and outcomes of the converse issue; namely, removal of metastatic extrarenal foci of RCC.

Sites of metastatic disease are widespread. Nearly every organ in the body has had reports of metastatic RCC. However, the main sites of metastatic disease are, in order of decreasing frequency, lung, bone, brain, liver/pancreas, and retroperitoneum (Indian J Cancer 2005; 42:173-7). It is important to note that most studies focus on the most prevalent RCC histologic subtype; namely, clear cell RCC, which may not permit extending conclusions to other histologic subtypes. Clear cell RCC histology characterizes as much as 85% to 90% of the patients with metastatic RCC.

The largest of these studies is from Memorial Sloan-Kettering Cancer Center, New York, where 278 patients undergoing resection of metastatic RCC over a 13-year period were studied (J Clin Oncol 1998; 16:2261-6). In this cohort were 42 patients with metastatic disease who did not undergo nephrectomy and who had a median survival of 10 months without a single survivor at 5 years.