Kidney Cancer — Surgery of Metastases
The management of the solitary metastasis from renal cell cancer is not in dispute: it is agreed that where the anatomical site of the metastasis lends itself to surgical excision, the metastasis ought to be resected, and it is equally clear that when surgical removal is not feasible, then radiotherapy may give immediate relief of pain and sometimes prolonged freedom from recurrence. The only thing that perhaps deserves a comment, a propos solitary metastases, is their astonishing vascularity — a fact which is little mentioned in textbooks and which seems to be one of those things which we all have to learn by experience. Nobody who has had to face the unbelievable torrent of haemorrhage that may follow biopsy of a metastasis from a Grawitz tumour will ever undertake such a minor procedure lightly, or without plenty of blood in reserve to meet such a dramatic crisis, The main topic for debate is the management of the patient who presents with multiple metastases: is it justifiable to attempt to take out the kidney? (1,2). The literature is unhelpful on the topic. Surgeons who have a patient whose metastases have disappeared after removal of the primary in the kidney tend to report such an unexpected miracle. Those of us who are less successful do not report our failures.
KeywordsRenal Cel1 Carcinoma Renal Cell Cancer Supraclavicular Node Horseshoe Kidney Minor Procedure
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