Strategies and outcomes in pulmonary and extrapulmonary metastases from renal cell cancer.

OBJECTIVE

Resected renal carcinoma related lung metastases (LM) are associated with higher survival rates, but surgery for extrapulmonary metastases affords good results too. Patients operated on for extrapulmonary metastases before thoracotomy are at high risk of death. The purpose of our analysis was to explore the surgical impact on the outcome of patients with such association.

METHODS

We reviewed the data of 15 patients operated for LM and extrapulmonary metastases from 1984 to 2005. We studied demographic and clinical characteristics, surgical results and pathological staging of the primary tumour and LM in search of prognostic factors.

RESULTS

Nephrectomy and metastasectomies were synchronous in only one patient. For the others, mean time interval between nephrectomy and surgery for LM was 74.2 months (range 19-228). Metastases were resected synchronously in two patients and metachronously in 13 of them (mean time interval: 28 months). Five-year survival of this group was 32%, median value of 18 months. The prognosis was better when the resected extrapulmonary metastases were located in the perirenal (pancreas, adrenal gland) or intrathoracic structures (lymph nodes, diaphragm) than in distant visceral organs (brain, bone, thyroid gland). The lymphatic drainage for these structures connects with the thoracic duct in a similar manner as kidneys do.

CONCLUSION

Surgery for lung and extrapulmonary renal cell cancer-related metastases provides favourable results and is indicated when complete resection can be achieved. The role of the lymphatic system must be explored by further investigations.