Study on clinical courses of 7 patients undergone resection of adjacent organs in the treatment of locally extensive renal cell carcinoma

Abstract

Significance of surgical extirpation of a massive tumor involving adjacent viscera is still controversial, because this sort of extensive resection is unusual and its results are poor in terms of a short survival time. Here, we summarize the clinical courses of 7 patients who had been diagnosed as invasive renal cell carcinoma (RCC) and undergone extensive resection of the bowel and/or other adjacent visceras. In addition, a percentage of patients who had direct invasion and/or metastasis to adjacent viscera in routine autopsies was looked up in the Annual Report of the Pathological Autopsy Cases in Japan. Pathological diagnosis indicated that direct invasion was confirmed in 4 out of 7 patients. One patient was relieved from septic shock due to pelvicocolic fistula caused by a direct invasion of RCC. New metastases developed in all patients after the radical operation (2 - 30 mos), and 3 of them further underwent resection of the metastastic lesion(s). Although 5 patients ultimately died of cancer or its related diseases (mean survival time: 14.2 +/- 10.7 mos), other 2 (pT4 and pT3) who underwent resection of lung metastasis have survived for 19 and 72 months. Either an early occurrence of metastasis after local resection or a tumor predominantly composing of spindle cells might indicate a poor prognosis. Surgical extirpation should not be precluded when the patient is having severe symptoms related to extensive involvement of the adjacent visceras. We believe that it is appropriate to individualize in case of choosing patients for such extended radical surgery.