Role of surgery in metastatic renal cell carcinoma.

In summary, although it is associated with only about a 10% 1-year survival, palliative nephrectomy in the rare patient with symptoms directly referable to the primary tumor is justified to reduce patient suffering. However, non-surgical palliation with renal infarction techniques have been shown to produce effective palliation for the majority of symptoms referable to the primary lesion. In patients with resectable low-volume metastases, a combination of nephrectomy with removal of all visible metastases may be expected to result in a 35% 5-year survival rate with some patients displaying long-term survival. Palliative nephrectomy in patients with non-resectable (high volume) metastases can currently only be recommended for patients in whom adjuvant experimental therapy will be employed in addition to nephrectomy. I believe that these patients should be enrolled in carefully controlled and monitored prospective clinical trials.