Advanced-stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection.
OBJECTIVE
To examine the effect of radical nephrectomy (RN) with adjacent organ and structure resection on survival, as invasion of adjacent organs in patients with renal cell carcinoma (RCC) is rare.


METHODS
After institutional review board approval, we reviewed our database and statistically analysed of patients with pathological stage T3 or T4 RCC who had RN and resection of a contiguous organ or structure.


RESULTS
We identified 38 patients of 2464 (1.5%) who had RN with adjacent organ or structure resection. The median (interquartile range) size of the mass was 11 (8-14) cm, and the follow-up 13 (5-33) months. Most patients (68%) were pT4 stage and had conventional clear cell carcinoma (95%). Fourteen patients (37%) had positive surgical margins. The liver (10) was the most commonly resected adjacent organ or structure. Only one patient remains alive with no evidence of disease at 5 years, while three are currently alive with disease. Overall, 34 of 38 patients (90%) ultimately died from disease at a median (range) of 11.7 (5.4-29.2) months after surgical resection. The surgical margin status was the only statistically significant factor for recurrence and death (P = 0.006).


CONCLUSIONS
The prognosis for patients with advanced RCC and adjacent organ or structure involvement is extremely poor and similar to that of patients with metastatic disease. These patients should be thoroughly counselled about the impact of surgical management and considered for entry into neoadjuvant or adjuvant clinical trials with new targeted systemic agents.
Karellas
Michael E
ME
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
Jang
Thomas L
TL
Kagiwada
Megan A
MA
Kinnaman
Michael D
MD
Jarnagin
William R
WR
Russo
Paul
P
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
J Urol. 2007 Nov;178(5):1883-7
17868732
J Urol. 2005 Jan;173(1):48-51
15592023
BJU Int. 2008 Jun;101(11):1339-42
18284408
J Urol. 2004 Mar;171(3):1071-6
14767273
Cancer. 1971 Nov;28(5):1165-77
5125665
ScientificWorldJournal. 2007 Feb 19;7:768-78
17619759
N Engl J Med. 1996 Sep 19;335(12):865-75
8778606
J Urol. 2008 Jan;179(1):81-6; discussion 86
17997441
BJU Int. 2002 Apr;89(6):523-5
11942956
Cancer. 2007 May 15;109(10):2025-30
17420980
Lancet. 2001 Sep 22;358(9286):966-70
11583750
CA Cancer J Clin. 2008 Mar-Apr;58(2):71-96
18287387
N Engl J Med. 2001 Dec 6;345(23):1655-9
11759643
Eur Urol. 2006 Sep;50(3):521-8; discussion 529
16530322
Bull Am Coll Surg. 2002 Jul;87(7):13-5
17387902
World J Urol. 2006 Aug;24(3):255-66
16479388
J Clin Oncol. 2006 Jul 1;24(19):3101-6
16809736
JAMA. 2006 Jun 7;295(21):2516-24
16757724
J Clin Oncol. 2006 Jun 1;24(16):2505-12
16636341