Introduction: Clear cell renal cell carcinoma (ccRCC) is the most common kidney tumor. If feasible, metastasectomy is preferably indicated in metastatic disease. Objective: The aim of this study was to determine the outcome of patients after pulmonary metastasectomy (PM). Methods: PM for ccRCC was performed in 35 patients in the period of January 2001–2019. Clinical characteristics, type of surgery, histopathology results, and follow-up data were recorded. Progression-free survival (PFS) after PM and overall survival (OS) were defined as outcome endpoints. Results: A total of 77 PMs were performed in 35 patients after nephrectomy for ccRCC. The mean size of pulmonary metastasis was 19.0 mm (4–90). With a median follow-up after PM of 79.2 months, the 3- and 5-year OS rates were 63.5 and 44.9%, respectively. The only statistically significant prognostic factor affecting both PFS (p = 0.019) and OS (p = 0.015) was the dimension of pulmonary metastases. Conclusions: The prognosis of metastatic ccRCC is generally poor, particularly in cases of larger size of metastasis. PM might improve the individual prognosis of patients with lung metastasis even in cases with higher number of metastases, bilaterality, synchronous metastasis, or a short progression-free interval after nephrectomy.

Keywords:
Metastasectomy, Pulmonary metastasis, Clear cell renal cell carcinoma
1.
Ljungberg B, Albiges L, Abu-Ghanem Y, Bensalah K, Dabestani S, Fernández-Pello S, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update.
Eur Urol
. 2019 May;75(5):799–810.
2.
Moch H, Humphrey PH, Ulbright TM, Reuter VE. WHO Classification of Tumours of the Urinary System and male Genital Organs (4th edition). IARC: 2016. p. 356.
3.
Epidemiology of malignant tumors in the Czech Republic: 2015 (accessed March 8, 2019). Publishing Official Portal of the Czech National Cancer Control Programme. Available from: http://www.svod.cz.
4.
Hofmann HS, Neef H, Krohe K, Andreev P, Silber RE. Prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma.
Eur Urol
. 2005 Jul;48(1):77–81.
5.
Meimarakis G, Angele M, Staehler M, Clevert DA, Crispin A, Rüttinger D, 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 Aug;202(2):158–67.
6.
Kavolius JP, Mastorakos DP, Pavlovich C, Russo P, Burt ME, Brady MS. Resection of metastatic renal cell carcinoma.
J Clin Oncol
. 1998 Jun;16(6):2261–6.
7.
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 Nov;74(5):1653–7.
8.
Piltz S, Meimarakis G, Wichmann MW, Hatz R, Schildberg FW, Fuerst H. Long-term results after pulmonary resection of renal cell carcinoma metastases.
Ann Thorac Surg
. 2002 Apr;73(4):1082–7.
9.
Kanzaki R, Higashiyama M, Fujiwara A, Tokunaga T, Maeda J, Okami J, 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 Feb;39(2):167–72.
10.
Meacci E, Nachira D, Congedo MT, Porziella V, Chiappetta M, Ferretti G, et al. Lung metastasectomy following kidney tumors: outcomes and prognostic factors from a single-center experience.
J Thorac Dis
. 2017 Oct;9(S12 suppl 12):S1267–72.
11.
Murthy SC, Kim K, Rice TW, Rajeswaran J, Bukowski R, DeCamp MM, et al. Can we predict long-term survival after pulmonary metastasectomy for renal cell carcinoma?
Ann Thorac Surg
. 2005 Mar;79(3):996–1003.
12.
Chen F, Fujinaga T, Shoji T, Miyahara R, Bando T, Okubo K, et al. Pulmonary resection for metastasis from renal cell carcinoma.
Interact Cardiovasc Thorac Surg
. 2008 Oct;7(5):825–8.
13.
Ohtaki Y, Shimizu K, Aokage K, Nakao M, Yoshida J, Kamiyoshihara M, et al. Histology is a Prognostic Indicator After Pulmonary Metastasectomy from Renal Cell Carcinoma.
World J Surg
. 2017 Mar;41(3):771–9.
14.
Assouad J, Petkova B, Berna P, Dujon A, Foucault C, Riquet M. Renal cell carcinoma lung metastases surgery: pathologic findings and prognostic factors.
Ann Thorac Surg
. 2007 Oct;84(4):1114–20.
15.
Cerfolio RJ, Allen MS, Deschamps C, Daly RC, Wallrichs SL, Trastek VF, et al. Pulmonary resection of metastatic renal cell carcinoma.
Ann Thorac Surg
. 1994 Feb;57(2):339–44.
16.
Kawashima A, Nakayama M, Oka D, Sato M, Hatano K, Mukai M, et al. Pulmonary metastasectomy in patients with renal cell carcinoma: a single-institution experience.
Int J Clin Oncol
. 2011 Dec;16(6):660–5.
17.
Friedel G, Hürtgen M, Penzenstadler M, Kyriss T, Toomes H. Resection of pulmonary metastases from renal cell carcinoma.
Anticancer Res
. 1999 Mar-Apr;19 2C:1593–6.
18.
Jett JR, Hollinger CG, Zinsmeister AR, Pairolero PC. Pulmonary resection of metastatic renal cell carcinoma.
Chest
. 1983 Oct;84(4):442–5.
19.
Morrow CE, Vassilopoulos PP, Grage TB. Surgical resection for metastatic neoplasms of the lung: experience at the University of Minnesota Hospitals.
Cancer
. 1980 Jun;45(12):2981–5.
20.
Heinzer H, Huland E, Huland H. [Treatment of metastatic renal cell carcinoma. Value of immunotherapy compared with surgery of metastases].
Urologe A
. 2000 Jul;39(4):356–61.
21.
Dabestani S, Marconi L, Bex A. Metastasis therapies for renal cancer.
Curr Opin Urol
. 2016 Nov;26(6):566–72.
22.
Thiery-Vuillemin A, Cholley T, Calcagno F, Hugues M, Maurina T, Limat S, et al.
Factors Influencing Overall Survival for Patients With Metastatic Clear-Cell Renal-Cell Carcinoma in Daily Practice.
Clin Genitourin Cancer 2018;16:e297–e305.
23.
Brierley D. James, Gospodarowicz K. Mary, Wittekind Christian: TNM Classification of Malignant Tumours, 8th Edition. Wiley-Blackwell.
24.
Marulli G, Sartori F, Bassi PF, dal Moro F, Gino Favaretto A, Rea F. Long-term results of surgical management of pulmonary metastases from renal cell carcinoma.
Thorac Cardiovasc Surg
. 2006 Dec;54(8):544–7.
25.
Fourquier P, Regnard JF, Rea S, Levi JF, Levasseur P. Lung metastases of renal cell carcinoma: results of surgical resection.
Eur J Cardiothorac Surg
. 1997 Jan;11(1):17–21.
26.
Pogrebniak HW, Haas G, Linehan WM, Rosenberg SA, Pass HI. Renal cell carcinoma: resection of solitary and multiple metastases.
Ann Thorac Surg
. 1992 Jul;54(1):33–8.
27.
Dineen MK, Pastore RD, Emrich LJ, Huben RP. Results of surgical treatment of renal cell carcinoma with solitary metastasis.
J Urol
. 1988 Aug;140(2):277–9.
28.
Dernevik L, Berggren H, Larsson S, Roberts D. Surgical removal of pulmonary metastases from renal cell carcinoma.
Scand J Urol Nephrol
. 1985;19(2):133–7.
29.
Kierney PC, van Heerden JA, Segura JW, Weaver AL. Surgeon’s role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review.
Ann Surg Oncol
. 1994 Jul;1(4):345–52.
30.
Dabestani S, Marconi L, Hofmann F, Stewart F, Lam TB, Canfield SE, et al. Local treatments for metastases of renal cell carcinoma: a systematic review.
Lancet Oncol
. 2014 Nov;15(12):e549–61.
31.
Renaud S, Falcoz PE, Alifano M, Olland A, Magdeleinat P, Pagès O, et al. Systematic lymph node dissection in lung metastasectomy of renal cell carcinoma: an 18 years of experience.
J Surg Oncol
. 2014 Jun;109(8):823–9.
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