Annals of Surgical Oncology

, Volume 1, Issue 4, pp 345–352

Surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: An institutional review

  • Philip C. Kierney
  • Jon A. van Heerden
  • Joseph W. Segura
  • Amy L. Weaver


Background: Solitary metastases from a primary renal cell carcinoma (RCC) occur in <10% of patients with metastatic RCC. To date, the benefit of surgically resecting such apparently solitary lesions has not been well documented.

Materials and Methods: Forty-one patients (25 men, 16 women) with metastatic renal cell carcinoma treated by surgical excision of solitary metastases (1970–1990) were retrospectively reviewed. They comprised 9% of patients with metastatic hypernephroma seen during this period. All patients had undergone previous curative nephrectomy with a median disease-free interval of 27 months. Patients with skeletal, spinal cord, and lymph node metastases were excluded.

Results: Mevtastases were intrathoracic (n=20), intracranial (n=7), and intraabdominal or in the extrapleural chest wall soft tissue (n=10). Three patients had metastases to the thyroid gland and one had a solitary metastasis to an index finger. Median follow-up was 3.2 years. Complete resection was possible in 36 patients (88%) with a single lesion excised in 23 of these 36 patients (64%). There was no operative mortality. Predicted survival from the date of complete resection of metastases was 77%, 59%, and 31% at 1, 3, and 5 years, respectively, with a median survival of 3.4 years. One patient is alive without evidence of recurrent tumor 93 months from the first of 12 complete surgical resections. Varying adjuvant therapy was used in 50% of the patients. An increased histological tumor grade of the metastatic lesion relative to the original RCC was the only significant prognostic indicator identified. Disease-free interval and number of resected lesions were not significantly associated with patient survival.

Conclusion: A small fraction of renal cell carcinoma patients are candidates for potentially curative surgical resection of solitary metastatic lesions. Excision of such lesions may contribute to prolonged survival in selected instances.

Key Words

Resection Metastasis Solitary Hypernephroma Nephrectomy 


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  1. 1.
    Golimbu M, Joshi P, Sperber A, Tessler A, Al-Askari S, Morales P. Renal cell carcinoma: survival and prognostic factors.Urology 1986;27:291–301.CrossRefPubMedGoogle Scholar
  2. 2.
    Silverberg E, Lubera J.Cancer Stat 1987;37:2.Google Scholar
  3. 3.
    Pontes JE. Adjunctive treatment for renal cell carcinoma.Int Adv Surg Oncol 1983;6:309.PubMedGoogle Scholar
  4. 4.
    Maldazys JD, deKernion JB. Prognostic factors in metastatic renal carcinoma.J Urol 1986;136:376–9.PubMedGoogle Scholar
  5. 5.
    Ritchie AWS, deKernion JB. The natural history and clinical features of renal carcinoma.Semin Nephrol 1987;7:131–9.PubMedGoogle Scholar
  6. 6.
    Dineen MK, Pastore RD, Emrich LJ, Huben RP. Results of surgical treatment of renal cell carcinoma with solitary metastasis.J Urol 1988;140:277–9.PubMedGoogle Scholar
  7. 7.
    Barney JD, Churchill EJ. Adenocarcinoma of the kidney with metastasis to the lung: cured by nephrectomy and lobectomy.J Urol 1939;42:269–76.Google Scholar
  8. 8.
    Tolia BM, Whitmore WF Jr. Solitary metastasis from renal cell carcinoma.J Urol 1975;114:836–8.PubMedGoogle Scholar
  9. 9.
    Middleton RG. Surgery for metastatic renal cell carcinoma.J Urol 1967;97:973–7.PubMedGoogle Scholar
  10. 10.
    Skinner DG, Vermillion CD, Colvin RB. The surgical management of renal cell carcinoma.J Urol 1972;107:705.PubMedGoogle Scholar
  11. 11.
    Patel NP, Lavengood RW. Renal cell carcinoma: natural history and results of treatment.J Urol 1978;119:722–6.PubMedGoogle Scholar
  12. 12.
    Lokich JJ, Harrison JH. Renal cell carcinoma: natural history and chemotherapeutic experience.J Urol 1975;114:371–4.PubMedGoogle Scholar
  13. 13.
    Rosenberg SA, Lotze MT, Muul LM, et al. Observations on the systemic administration of autologous lymphokine-activated killer cells and recombinant interleukin-2 to patients with metastatic cancer.N Engl J Med 1985;313:1485–92.CrossRefPubMedGoogle Scholar
  14. 14.
    O'Dea MJ, Zincke H, Utz DC, Bernatz PE. The treatment of renal cell carcinoma with solitary metastases.J Urol 1978;120:540–2.PubMedGoogle Scholar
  15. 15.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations.J Am Stat Assoc 1958;53:457–81.CrossRefGoogle Scholar
  16. 16.
    Peto R, Peto J. Asymptomatically efficient rank invariant test procedures.J R Stat Soc 1972;135:185–98.CrossRefGoogle Scholar
  17. 17.
    Riches EN, Griffiths IH, Thackray AC. New growths of the kidney and ureter.Br J Urol 1951;23:297–356.CrossRefPubMedGoogle Scholar
  18. 18.
    Scheele J, Stangle R, Altendorf-Hofmann A. Hepatic metastasis from colorectal carcinoma: impact of surgical resection on the natural history.Br J Surg 1990;77:1241.CrossRefPubMedGoogle Scholar
  19. 19.
    Hughes K, Rosenstein R, Songhosabodi S, et al. Resection of the liver for colorectal carcinoma metastases. A multi-institutional study of long-term survivors.Dis Colon Rectum 1988;31:1.CrossRefPubMedGoogle Scholar
  20. 20.
    Jett JR, Hollinger CG, Zinsmeister AR, Pairolero PC. Pulmonary resection of metastatic renal cell carcinoma.Chest 1983;84:442–5.CrossRefPubMedGoogle Scholar
  21. 21.
    Creagan ET, Fleming TR, Edmonson JH, Pairolero PC. Pulmonary resection for metastatic nonosteogenic sarcoma.Cancer 1979;44:1908–12.CrossRefPubMedGoogle Scholar
  22. 22.
    Rauschmeier H, Hofstädter F, Jakse G. Tumor grading: an important prognostic factor in renal cell carcinoma.World J Urol 1984;2:103–8.CrossRefGoogle Scholar
  23. 23.
    Vetter JM. Metastasis of renal-cell carcinoma: a pathologist's theoretical view. In:EORTC Genitourinary Group monograph 9: Basic research and treatment of renal cell carcinoma metastasis. 1990:13–22.Google Scholar
  24. 24.
    Takita H, Edgerton F, Vincent RG, Gutierrez AC. Surgical management of lung metastasis. In: Weiss L, Gilbert H, eds.Pulmonary metastasis. Boston: GK Halland, 1978:243–51.Google Scholar
  25. 25.
    Lemmers M, Ward K, Hatch T, Stenzel P. Renal adenocarcinoma with solitary metastasis to the contralateral adrenal gland: report of 2 cases and review of the literature.J Urol 1989;141:1177–80.PubMedGoogle Scholar
  26. 26.
    Hasegawa J, Okumura S, Abe H, Kanamori S, Yoshida K, Akimoto M. Renal cell carcinoma with solitary contralateral adrenal metastasis.Urology 1988;32:52–3.CrossRefPubMedGoogle Scholar
  27. 27.
    Mentor A, Boyd AS, McCaffree DM. Recurrent renal cell carcinoma presenting as skin nodules: two case reports and review of the literature.Cutis 1989;44:305–8.Google Scholar
  28. 28.
    Marshall ME, Pearson T, Simpson W, Butler K, McRoberts W. Low incidence of asymptomatic brain metastases in patients with renal cell carcinoma.Urology 1990;36:300–2.CrossRefPubMedGoogle Scholar

Copyright information

© The Society of Surgical Oncology, Inc 1994

Authors and Affiliations

  • Philip C. Kierney
    • 3
  • Jon A. van Heerden
    • 3
  • Joseph W. Segura
    • 1
  • Amy L. Weaver
    • 2
  1. 1.Department of UrologyMayo Clinic and Mayo FoundationRochesterUSA
  2. 2.the Section of BiostatisticsMayo Clinic and Mayo FoundationRochesterUSA
  3. 3.Section of Gastroenterologic and General SurgeryMayo ClinicRochesterUSA

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