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The Annals of Thoracic Surgery, Vol 57, 339-344, Copyright © 1994 by The Society of Thoracic Surgeons
RJ Cerfolio, MS Allen, C Deschamps, RC Daly, SL Wallrichs, VF Trastek and PC Pairolero
Between 1965 and 1989, 96 consecutive patients (64 men and 32 women)
underwent complete pulmonary resection for metastatic renal cell carcinoma.
Median age was 63 years (range, 33 to 82 years). Median time between
nephrectomy and pulmonary resection was 3.4 years (range, 0 to 18.4 years).
Forty-eight patients had solitary metastasis, 16 had two, 18 had three, and
14 had more than three. Wedge excision was performed in 62 patients,
segmentectomy in 3, lobectomy in 25, bilobectomy in 3, and pneumonectomy in
3. Fourteen patients had repeat thoracotomy for recurrent metastasis; 34
other patients also had complete resection of limited extrapulmonary
disease. There were no operative deaths. Median follow-up was 3 years
(range, 70 days to 19.0 years). Overall 5-year survival was 35.9%. Patients
with solitary metastasis had a 5-year survival of 45.6% compared with 27.0%
for patients with multiple metastases (p < 0.05). Patients with a
tumor-free interval greater than the median of 3.4 years had a better
survival (p = 0.05) than those with a tumor-free interval less than or
equal to 3.4 years. Five-year survival for patients who underwent repeat
thoracotomy or had complete resection of extrapulmonary disease did not
differ from overall survival. We conclude that resection of renal lung
metastasis is safe and effective, that patients with solitary metastasis
have a better survival than those with multiple metastases, that resectable
extrapulmonary disease does not necessarily contra-indicate pulmonary
resection, and that repeat thoracotomy is warranted in selected patients
with recurrent lung metastases.
ARTICLES
Pulmonary resection of metastatic renal cell carcinoma
Section of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55905.
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