The exact role of surgery for patients with metastatic renal cell cancer has not been defined. However, it is known that resection of a single metastasis from renal cell cancer can result in 5-year survivals of 35-50% in selected patients. Physicians at Memorial Sloan-Kettering analyzed their experience with 278 patients with recurrent renal cell cancer and reported the results of their experience in the
Journal of Clinical Oncology. One hundred forty-five of 278 patients had surgery with the intent to cure, 70 patients underwent surgery for palliation to decrease symptoms, and 67 were treated non-surgically.
Patients who had surgical treatment of a recurrence more than 1 year after initial diagnosis had a survival of 55% compared to 9% for patients with a recurrence within the first year of diagnosis. Patients with a solitary recurrence had a 5-year survival of 54% compared to 29% for patients with multiple metastases. Patients with a solitary lung recurrence had a 5-year survival of 54% compared to 18% for those with a solitary recurrence in the brain.
Survival rates after curative resection of second and third metastases were not different when compared with initial surgery.
This study emphasizes the importance of the role that surgical resection plays in the treatment of patients with metastatic renal cell cancer. It is also important to consider surgery when immunotherapy produces a partial response as surgery can change a partial to a complete response.
(Journal of Clinical Oncology, Vol 16, No 6, pp 2261-2266, 1998)