Outcome of Repeated Resection of Pulmonary Metastases for Renal Cell Cancer

Abstract

Background To date, many studies investigated results and prognostic factors of pulmonary metastasectomy (PM) in renal cell cancer (RCC). However, reports concerning repeated resection for patients with recurrent pulmonary metastases (RPM) are limited. In this study, we analyzed safety, efficacy, and prognostic factors for survival after PM focusing on RPM for RCC.

Patients and Methods Clinical, operative, and follow-up data of patients who underwent PM or RPM for RCC in our institution were retrospectively collected and correlated with each other from January 2005 to December 2019.

Results Altogether 154 oncological pulmonary resections in curative intention as PM or RPM were performed in 82 and 26 patients. Postoperative complications were similar in both groups (n = 22 [26.8%] vs. 4 [15.4%], p = 0.2). Zero mortality was documented up to the 30th postoperative day. RPM was not associated with decreased 5-year-survival compared with PM (66.2 vs. 57,9%, p = 0.5). Patients who underwent RPM for recurrent lung metastases had a better overall survival in comparison with the other treatments including chemotherapy, radiotherapy, immunotherapy, and best supportive care (p = 0.04). In the multivariate analysis, disease-free survival was identified as an independent prognostic factor for survival (hazard ratio: 0.969, 0.941–0.999, p = 0.04).

Conclusion RPM is a safe and feasible procedure. The resection of recurrent lung metastases shows to prolong survival in comparison with the other therapeutic options for selected patients with RCC.

Keywords

metastases/metastasectomy - tumor - surgery - complications

Publikationsverlauf

Eingereicht: 27. April 2022

Angenommen: 18. Juli 2022

Artikel online veröffentlicht:
20. August 2022

• References

• 1 Macherey S, Kauffmann C, Heidenreich A, Doerr F, Wahlers T, Hekmat K. [Pulmonary metastasectomy in renal cell carcinoma]. Urologe A 2017; 56 (08) 1025-1030
• 2 Staehler M. The role of metastasectomy in metastatic renal cell carcinoma. Nat Rev Urol 2011; 8 (04) 180-181
• 3 Chen F, Fujinaga T, Shoji T. et al. Pulmonary resection for metastasis from renal cell carcinoma. Interact Cardiovasc Thorac Surg 2008; 7 (05) 825-828
• 4 Pfannschmidt J, Egerer G, Bischof M, Thomas M, Dienemann H. Surgical intervention for pulmonary metastases. Dtsch Arztebl Int 2012; 109 (40) 645-651
• 5 Treasure T, Fiorentino F, Scarci M, Møller H, Utley M. Pulmonary metastasectomy for sarcoma: a systematic review of reported outcomes in the context of Thames Cancer Registry data. BMJ Open 2012; 2 (05) e001736
• 6 Kon Z, Martin L. Resection for thoracic metastases from sarcoma. Oncology (Williston Park) 2011; 25 (12) 1198-1204
• 7 Meimarakis G, Angele M, Staehler M. et al. Evaluation of a new prognostic score (Munich score) to predict long-term survival after resection of pulmonary renal cell carcinoma metastases. Am J Surg 2011; 202 (02) 158-167
• 8 Pfannschmidt J, Hoffmann H, Muley T, Krysa S, Trainer C, Dienemann H. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 2002; 74 (05) 1653-1657
• 9 Winter H, Meimarakis G, Angele MK. et al. Tumor infiltrated hilar and mediastinal lymph nodes are an independent prognostic factor for decreased survival after pulmonary metastasectomy in patients with renal cell carcinoma. J Urol 2010; 184 (05) 1888-1894
• 10 Kanzaki R, Higashiyama M, Fujiwara A. et al. Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience. Eur J Cardiothorac Surg 2011; 39 (02) 167-172
• 11 Seely AJ, Ivanovic J, Threader J. et al. Systematic classification of morbidity and mortality after thoracic surgery. Ann Thorac Surg 2010; 90 (03) 936-942 , discussion 942
• 12 Murthy SC, Kim K, Rice TW. et al. Can we predict long-term survival after pulmonary metastasectomy for renal cell carcinoma?. Ann Thorac Surg 2005; 79 (03) 996-1003
• 13 Renaud S, Falcoz PE, Alifano M. et al. Systematic lymph node dissection in lung metastasectomy of renal cell carcinoma: an 18 years of experience. J Surg Oncol 2014; 109 (08) 823-829
• 14 Forster C, Ojanguren A, Perentes JY. et al. Is repeated pulmonary metastasectomy justified?. Clin Exp Metastasis 2020; 37 (06) 675-682
• 15 Pastorino U, Buyse M, Friedel G. et al; International Registry of Lung Metastases. Long-term results of lung metastasectomy: prognostic analyses based on 5206 cases. J Thorac Cardiovasc Surg 1997; 113 (01) 37-49
• 16 Kudelin N, Bölükbas S, Eberlein M, Schirren J. Metastasectomy with standardized lymph node dissection for metastatic renal cell carcinoma: an 11-year single-center experience. Ann Thorac Surg 2013; 96 (01) 265-270 , discussion 270–271
• 17 Sponholz S, Schirren M, Baldes N, Oguzhan S, Schirren J. Repeat resection for recurrent pulmonary metastasis of colorectal cancer. Langenbecks Arch Surg 2017; 402 (01) 77-85
• 18 Menna C, Berardi G, Tierno SM. et al. Do repeated operations for recurrent colorectal lung metastases result in improved survival?. Ann Thorac Surg 2018; 106 (02) 421-427
• 19 Rodríguez-Fuster A, Belda-Sanchis J, Aguiló R. et al; GECMP-CCR-SEPAR. Morbidity and mortality in a large series of surgical patients with pulmonary metastases of colorectal carcinoma: a prospective multicentre Spanish study (GECMP-CCR-SEPAR). Eur J Cardiothorac Surg 2014; 45 (04) 671-676
• 20 Onaitis MW, Petersen RP, Haney JC. et al. Prognostic factors for recurrence after pulmonary resection of colorectal cancer metastases. Ann Thorac Surg 2009; 87 (06) 1684-1688
• 21 Zhao Y, Li J, Li C, Fan J, Liu L. Prognostic factors for overall survival after lung metastasectomy in renal cell cancer patients: a systematic review and meta-analysis. Int J Surg 2017; 41: 70-77
• 22 Jett JR, Hollinger CG, Zinsmeister AR, Pairolero PC. Pulmonary resection of metastatic renal cell carcinoma. Chest 1983; 84 (04) 442-445
• 23 Salah S, Watanabe K, Park JS. et al. Repeated resection of colorectal cancer pulmonary oligometastases: pooled analysis and prognostic assessment. Ann Surg Oncol 2013; 20: 1955-1961
• 24 Welter S, Jacobs J, Krbek T. et al. Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg 2007; 84: 203-210