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Nephron sparing surgery in patients with metastatic renal cell carcinoma
V Krishnamurthi1, A C Novick, R Bukowski
1Department of Urology, Cleveland Clinic Foundation, Ohio 44195, USA.
Purpose:
We evaluated the role of nephron sparing surgery in patients with metastatic renal cell carcinoma.
Materials And Methods:
A total of 15 patients with metastatic renal cell carcinoma underwent nephron sparing surgery and treatment of metastases, including 4 who received adjunctive biological response modifier therapy. The 9 patients in group 1, who previously underwent contralateral nephrectomy for renal cell carcinoma and complete resection of all metastases, presented for treatment of localized renal cell carcinoma in the remaining kidney with no other evidence of disease. The 6 patients in group 2 presented with localized renal cell carcinoma requiring nephron sparing surgery and concomitant distant metastases. Mean postoperative followup was 30.4 months.
Results:
Of 9 patients in group 1, 6 (66.7%) were disease-free at a mean of 31.3 months after nephron sparing surgery and 102.2 months after detection of metastatic disease, while 3 (33.3%) died at a mean of 53.3 and 73.0 months, respectively. Among the 6 patients in group 2, 4 (66.7%) were disease-free at a mean followup of 16.8 months and 2 (33.3%) died at a mean of 20.5 months postoperatively. Of the 4 patients who received adjunctive biological response modifier therapy 3 were disease-free at a mean of 12.7 months and 1 died 7 months after treatment. Satisfactory overall renal function was preserved in 14 of 15 patients after nephron sparing surgery.
Conclusions:
We conclude that nephron sparing surgery can provide effective treatment for select patients with renal cell carcinoma and previously or recently treated metastatic disease.