[Surgical treatment of renal cell carcinoma associated with pulmonary metastasis].

Fifty-nine nephrectomies have been performed in patients with renal cell carcinoma during a 15-year-period from 1973 to 1987 in Fukuoka University Hospital. Of whom 13 had pulmonary metastasis and 10 had other organ metastasis. The 1, 3, 5-year survival rates in patients with metastasis were significantly worse than those without metastasis. No significant difference was observed between the survival rates in patients with pulmonary metastasis and other organ metastasis. Only 1-year-survival rate was better in patients with delayed metastasis after nephrectomy than that of patients with synchronous lung metastasis to the primary tumor. Resection of pulmonary metastasis was performed in 6 patients. Four of them, however, underwent another resection for recurrence in the lung. The average survival periods of the patients with and without surgical removal of pulmonary metastasis were almost same in the alive cases, but in the dead cases there was observed a 26-month-longer survival period in patients undergoing resection of metastatic lesion than those without resection. In conclusion, resection of pulmonary metastasis may not bring eradication of the disease in the majority of cases. However, aggressive surgery for pulmonary metastasis should be accepted because no effective adjuvant therapy is practically available in the treatment of renal cell carcinoma. Additionally, a case was reported of spontaneous regression of a pulmonary metastasis seen in a 61-year-old male with renal carcinoma. The lesion showed an apparent regression after radical nephrectomy on chest films and completely disappeared at 8 months postoperatively. After 9 months disease-free period, heterotopic recurrence developed in the same lung.(ABSTRACT TRUNCATED AT 250 WORDS)