Outcome following hepatic resection of metastatic renal tumors: the Paul Brousse Hospital experience.
BACKGROUND
As many as 50% of patients with renal cell carcinoma (RCC) will develop systemic metastases. When hepatic metastases from RCC present in a resectable distribution, our group and other groups have previously shown that some patients benefit from curative hepatic resection. In this report we update our own experience and summarize the literature published to date on this topic.


METHODS
From 1982 to 2005, 19 patients (9 men, 10 women, median age 50 years) with hepatic metastases from RCC were treated with hepatic resection at our institution. In 14 (74%) of the 19 patients the presentation of hepatic metastases was metachronous. Seven (37%) patients had been or were simultaneously treated for extrahepatic metastases. The mean tumor number was 2 and the mean diameter of the largest metastasis was 73 mm.


RESULTS
Margin-negative resection was achieved in 17 (89%) of 19 cases. Postoperative morbidity and mortality rates were 32% and 5%, respectively. At a median follow-up interval of 26 months, 15 patients recurred with a mean time to recurrence of 12 months. The 3-year and 5-year disease-free survival rates were 25% and 25%, respectively; 3-year and 5-year overall survival rates were 52% and 26%, respectively, with one patient alive 5 years following first hepatectomy. Study factors which predicted prolonged survivals included male sex and maximum tumor diameter </=5 cm.


CONCLUSIONS
The overall survival rates in our series (3-year, 52%; 5-year, 26%) and in a complete review of the literature (3-year, 24%; 5-year, 18%) indicate that selected patients with hepatic metastases from RCC benefit from hepatic resection.
Aloia
Thomas A
TA
Department of Surgery, Centre Hépato-Biliare, L'hôpital Paul Brousse, Villejuif, France.
Adam
René
R
Azoulay
Daniel
D
Bismuth
Henri
H
Castaing
Denis
D