Metastasectomy with standardized lymph node dissection for metastatic renal cell carcinoma: an 11-year single-center experience.

BACKGROUND: Pulmonary metastasectomy (PM) for metastatic renal cell carcinoma is an established method of treatment for selected patients. The incidence of intrathoracic lymph node metastases (ITLNM) and outcomes remain controversial. The purpose of this study was to determine the incidence of ITLNM and long-term outcome of PM for metastatic kidney cancer.

METHODS: From January 1999 to December 2009, 116 patients (82 men, age 61.7 ± 9.0 years) with metastases from kidney cancer underwent PM and systematic lymph node dissection with curative intent. Kaplan-Meier analyses, log-rank test, and Cox regression analyses were used to estimate survival and to determine prognosticators of survival.

RESULTS: Overall survival rates were 49% at 5 years and 21% at 10 years (median survival, 56.6 ± 9.2 months). Complete resections could be achieved in 108 patients (93.1%). Forty patients (34.5%) had systematic therapy before metastasectomy. Partial regression was observed in 11 patients (27.5%). Surgical morbidity and mortality rates were 13.8% (16 of 116) and 0.9% (1 of 116), respectively. ITLNM were found in 54 (46.6%). Patient age (≥ 70 years; p = 0.003), female gender (p = 0.016), and number of metastases (≥ 2 metastases; p = 0.012) were associated with inferior survival after PM in the univariate analysis. The presence of ITLNM and type of lung resection did not significantly affect survival. Patient age remained the only significant prognostic factor when a multivariate Cox proportional hazards model was applied.

CONCLUSIONS: PM and systematic lymph node dissection can be performed safely with low morbidity and mortality. Long-term survival is achievable in selected patients even with ITLNM. We recommend that systematic lymph node dissection should be demanded in every patient due to the high prevalence of ITLNM. Patients aged 70 years or older should be selected carefully for PM.