title: Nephrectomy for metastatic renal cell carcinoma: Indiana University experience.
abstract: OBJECTIVE
  To report on the short-term morbidity of radical nephrectomy in 32 patients with poorer performance status and more advanced primary renal cell carcinoma (RCC). Nephrectomy followed by immunotherapy has been shown to improve survival in selected, good performance status patients with metastatic RCC.
  
  
  METHODS
  We report on 32 patients who underwent radical nephrectomy (20 open procedures and 12 laparoscopic) in the setting of metastatic RCC at Indiana University between 1999 and 2002. The study group included patients with advanced primary tumors (inferior vena cava involvement, large size, and involvement of adjacent structures). The patients' performance status score ranged from 0 to 2.
  
  
  RESULTS
  The average hospital stay was 5.1 days. No significant intraoperative complications were encountered, and postoperative complications occurred in 6 patients, including one perioperative death. At 4 weeks postoperatively, 21 (72.4%) of 29 assessable patients had a performance status equal to, or better than, their preoperative status, including 4 patients who converted from a preoperative performance status of 2 to 0 or 1 postoperatively. Eleven patients (34.4%) went on to receive postoperative immunotherapy.
  
  
  CONCLUSIONS
  The results of our study demonstrated that radical nephrectomy in the setting of metastatic RCC has a low morbidity and acceptable recovery in these patients with advanced primary tumors and poorer performance status.
authors.affiliation: Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202-5289, USA.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mosharafa
authors.forename: Michael
authors.initials: M
authors.lastname: Koch
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalhav
authors.forename: Thomas
authors.initials: T
authors.lastname: Gardner
authors.forename: Theodore
authors.initials: T
authors.lastname: Logan
authors.forename: Richard
authors.initials: R
authors.lastname: Bihrle
authors.forename: Richard
authors.initials: R
authors.lastname: Foster
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007167:Immunotherapy; D007196:Indiana; D007680:Kidney Neoplasms / Q000601:surgery* / Q000628:therapy; D010535:Laparoscopy / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000556:secondary; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009392:Nephrectomy / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome