[Pulmonary resections for metastatic renal cell carcinoma in Iceland]

At the time of diagnosis, approximately 20% of renal cell carcinoma (RCC) patients have pulmonary metastasis. These patients have poor survival with less than 10% of the patients being alive 5 years after diagnosis. However, recent studies have reported 30-49% 5-year survival in selected patients that underwent pulmonary resection for RCC metastases. The aim of this study was to analyse the outcome of this patient group in Iceland over a 23 year period.

This is a retrospective population-based study including all patients in Iceland that underwent pulmonary resection for RCC metastasis between 1984 and 2006. Complications were tabulated and the histology of all tumors reviewed by a pathologist. The renal tumors were classified and staged according to the TNM staging system (WHO). Crude survival was calculated using 1st of March 2007 as an endpoint, with mean follow up of 82 months.

A total of 14 patients were identified, 10 males and 4 females with an average age of 59 years (range 45-78). One patient had pulmonary metastases at the diagnosis of RCC. In the other patients, metastasectomy was performed on average 39 months after the nephrectomy (range 1-132 months). Most of these patients (n=11) had a single metastasis, with an average size of 27 mm (range 8-50). Lobectomy was the most common procedure (n=7), wedge resection and pulmectomy were performed in three cases each, and one patient underwent both lobectomy and wedge resection. There were no major surgical complications. and all patients survived surgery. Today, four of the 14 patients (29%) are alive with 2- and 5-year survival of 64% and 29%, respectively.

In this retrospective study, every third patient survived five years after pulmonary resection of RCC metastases. This is a favorable survival-rate when compared to patients with metastases not operated on (9.8% survival). These operations seem to be safe and complications are most often minor. It should be kept in mind, however, that a selected cohort was studied and a well defined control group was absent.