[Management of advanced renal cell carcinoma: surgical treatment of metastasis]

The prognosis of advanced renal cell carcinoma, especially with metastatic lesions was very poor. We described the outcome of surgical treatment of advanced renal cell carcinoma with metastasis. From 1964 to 1992, 279 cases of renal cancer were treated in the Department of Urology, the Center for Adult Diseases, Osaka. Sixty four cases were with distant metastasis (M1 case) and 55 cases were recurrent after radical nephrectomy (M0-M1 case). Among these 119 cases with distant metastasis, 50 cases were treated by surgical resection. Indication of surgical resection was first to obtain surgical complete regression (sCR), second to improve quality of life (QOL). Lung metastases from 14 patients (M1, 5 cases; M0-M1, 9 cases) were resected. The survival of patients with unilateral lung metastases was significantly better than that of patients with bilateral lung metastases. Bone metastases from 18 patients (7 cases to obtain sCR, 11 cases to improve QOL) were resected. The prognosis of patients with bone metastasis was very poor, and more than a 3-year survival was seen in only patients histopathologically with grade 1. QOL improvement was observed in 9 of 11 patients (82%). Solitary adrenal metastasis showed a relatively good prognosis. Surgical resection of brain metastasis was performed only to improve QOL, because all patients had other metastases. Lymph node metastasis showed in general poor prognosis. Six cases with tumor thrombus extending into inferior vena cava nephrectomized under extracorporeal circulation.(ABSTRACT TRUNCATED AT 250 WORDS)