Distant metastasis of renal adenocarcinoma in nephrectomized cases.

In an analysis of the autopsy records of 1,828 patients with renal adenocarcinoma 424 nephrectomized and 1,404 nonnephrectomized cases were compared to explore the effect of nephrectomy on metastasis. Over-all, no significant difference was observed except for a high incidence of metastases to the brain and femur, and a low incidence of metastases to the ipsilateral adrenal and renal hilar lymph nodes in nephrectomized cases. No significant difference was seen between the nephrectomized and nonnephrectomized cases with metastatic involvement of 1 organ, with respect to the frequency with which any given organ was involved. There were 5 patients with metastasis in whom survival was 10 years or longer after nephrectomy. Lung metastasis was present in 4 cases and lymph node metastasis in 1. Of these 5 patients 3 had undergone nephrectomy only. The results failed to show any evidence of the effectiveness of nephrectomy or adjuvant therapy. It was inferred that the mode of metastasis and the clinical progress of patients after nephrectomy for renal adenocarcinoma are influenced more profoundly by characteristics of the tumor itself than by nephrectomy.