Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis

• Published in: World journal of urology Vol. 28; no. 4; pp. 543 - 547
• Main Authors: Staehler, Michael D., Kruse, Jessica, Haseke, Nicolas, Stadler, Thomas, Roosen, Alexander, Karl, Alexander, Stief, Christian G., Jauch, Karl W., Bruns, Christiane J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.08.2010; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Carcinoma, Renal Cell - mortality; Carcinoma, Renal Cell - secondary; Carcinoma, Renal Cell - surgery; Databases, Factual; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Kaplan-Meier Estimate; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidneys; Liver - surgery; Liver Neoplasms - mortality; Liver Neoplasms - secondary; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Nephrology. Urinary tract diseases; Oncology; Original Article; Proportional Hazards Models; Retrospective Studies; Tumors; Tumors of the urinary system; Urology; Young Adult; Metastasectomy; Liver metastases; Resection; Renal cell carcinoma; Survival; Surgery; Nephrology; Carcinoma; Hepatic disease; Urology; Grawitz tumor; Advanced stage; Kidney disease; Urinary system disease; Surgical resection; Malignant tumor; Retrospective; Treatment; Kidney cancer; Digestive diseases; Metastatic; Comparative study; Liver metastasis; Cancer; Prolonged
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-010-0560-4

The value of surgical resection of renal cell carcinoma (RCC) liver metastases still remains unclear. Objective Of our study was to evaluate the efficacy of liver resection by comparing patients who could have undergone metastasectomy due to limited disease, but refused surgery. Materials and methods Eighty-eight patients were identified with liver metastases and indication of surgery between 1995 and 2006. In 68 patients, liver resection was performed, 20 patients denied surgery and served as comparison group. Patients were followed for survival. Results Median age was 58. Median amount of liver metastases was 2 (range 1–30). Median follow-up was 26 months (range 1–187). In both groups, 79% received systemic therapy. The 5-year overall survival rate (OSR-5) after metastasectomy was 62.2% ± 11.4% (SEM) with a median survival (MS) of 142 (95% confidence interval (CI) 115–169) months. OSR-5 in the control group was 29.3% ± 22.0% (SEM) with a MS of 27 (95% CI 16–38) months ( P  = 0.003). MS was 155 (95% CI 133–175) months with metachronous metastases compared to 29 (95% CI 25–33) months in the comparison group ( P  = 0.001). Low-grade primary RCC had a MS of 155 (95% CI 123–187) months compared to 29 (95% CI 8–50) months without resection ( P  = 0.0036). High-grade RCC as well as patients with synchronous metastases did not benefit from surgery. Conclusions Liver metastasectomy is an independent valuable tool in the treatment of metastatic RCC and significantly prolongs patient’s survival, even if further systemic treatment is necessary. With the evidence given, patients may benefit from liver metastasis resection if technically feasible.