Abstract
PurposeDespite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative to surgery, therapeutical strategies in stage IV disease must be reevaluated.MethodsThis is a retrospective analysis of 40 patients undergoing hepatic resection of histologically confirmed RCC metastases at our institution between April 1993 and April 2017.ResultsThe interval between nephrectomy for renal cell carcinoma and hepatic metastasectomy was 44.0 months (3.3–278.5). Liver resections of different extents were performed, including multivisceral resections. The median follow-up was 37.8 months (0.5–286.5). Tumor recurrence after resection of hepatic metastases occurred in 19 patients resulting in a median disease-free survival of 16.2 months (0.7–265.1) and a median overall survival of 37.8 months (0.5–286.5). Multivariable analysis identified multivisceral resection as an independent risk factor for disease-free and overall survival (p = 0.043 and p = 0.001, respectively). A longer interval between nephrectomy and hepatic metastasectomy was identified as an independent significant protective factor for overall survival (p < 0.001). Patients undergoing metastasectomy after introduction of sunitinib in Europe in 2006 (n = 15) showed a significantly longer overall survival (45.2 (9.1–111.0) versus 27.5 (0.5–286.52) months in the preceding era; p = 0.038).ConclusionHepatic metastasectomy, including major and extended resections, on patients with metastasized renal cell carcinoma can be performed safely and may facilitate long-term survival. Due to significant morbidity and increased mortality, multivisceral resections must be weighed against other options, such as targeted therapy.
Highlights
Renal cell carcinoma (RCC) is a malignant disease with increasing incidence, ranging from 3 to 12 cases per 100,000 people in Europe and Northern America.Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Despite entering the era of novel targeted therapies such as tyrosine kinase inhibitors, mortality rates are still at more than 2.4 per 100,000 people in many Western countries [1]
This is partially owed to the fact that around 30% of the patients initially present themselves with synchronous distant metastases, whereas another 30% suffer from metachronous metastases after nephrectomy in curative intent [2]
Left and right nephrectomies were distributed among the patient cohort; one patient received bilateral nephrectomy
Summary
Renal cell carcinoma (RCC) is a malignant disease with increasing incidence, ranging from 3 to 12 cases per 100,000 people in Europe and Northern America. Despite entering the era of novel targeted therapies such as tyrosine kinase inhibitors, mortality rates are still at more than 2.4 per 100,000 people in many Western countries [1] This is partially owed to the fact that around 30% of the patients initially present themselves with synchronous distant metastases, whereas another 30% suffer from metachronous metastases after nephrectomy in curative intent [2]. Bone and lung lesions are most frequently observed in cases of metastatic disease, the liver is involved in 20% of the patients [3]. Studies in the past have analyzed the influence of metastasectomy in general on the disease-free and diseasespecific survival and showed beneficial effects for surgical resection in selected patients [4, 5]
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