title: Liver resection for metastatic disease prolongs survival in renal cell carcinoma: 12-year results from a retrospective comparative analysis.
abstract: The value of surgical resection of renal cell carcinoma (RCC) liver metastases still remains unclear.
  
  
  OBJECTIVE
  Of our study was to evaluate the efficacy of liver resection by comparing patients who could have undergone metastasectomy due to limited disease, but refused surgery.
  
  
  METHODS
  Eighty-eight patients were identified with liver metastases and indication of surgery between 1995 and 2006. In 68 patients, liver resection was performed, 20 patients denied surgery and served as comparison group. Patients were followed for survival.
  
  
  RESULTS
  Median age was 58. Median amount of liver metastases was 2 (range 1-30). Median follow-up was 26 months (range 1-187). In both groups, 79% received systemic therapy. The 5-year overall survival rate (OSR-5) after metastasectomy was 62.2% +/- 11.4% (SEM) with a median survival (MS) of 142 (95% confidence interval (CI) 115-169) months. OSR-5 in the control group was 29.3% +/- 22.0% (SEM) with a MS of 27 (95% CI 16-38) months (P = 0.003). MS was 155 (95% CI 133-175) months with metachronous metastases compared to 29 (95% CI 25-33) months in the comparison group (P = 0.001). Low-grade primary RCC had a MS of 155 (95% CI 123-187) months compared to 29 (95% CI 8-50) months without resection (P = 0.0036). High-grade RCC as well as patients with synchronous metastases did not benefit from surgery.
  
  
  CONCLUSIONS
  Liver metastasectomy is an independent valuable tool in the treatment of metastatic RCC and significantly prolongs patient's survival, even if further systemic treatment is necessary. With the evidence given, patients may benefit from liver metastasis resection if technically feasible.
authors.affiliation: Department of Urology, University of Munich, Klinikum Grosshadern, Marchioninistr. 15, 81377, München, Germany. michael.staehler@med.uni-muenchen.de
authors.forename: Michael D
authors.initials: MD
authors.lastname: Staehler
authors.forename: Jessica
authors.initials: J
authors.lastname: Kruse
authors.forename: Nicolas
authors.initials: N
authors.lastname: Haseke
authors.forename: Thomas
authors.initials: T
authors.lastname: Stadler
authors.forename: Alexander
authors.initials: A
authors.lastname: Roosen
authors.forename: Alexander
authors.initials: A
authors.lastname: Karl
authors.forename: Christian G
authors.initials: CG
authors.lastname: Stief
authors.forename: Karl W
authors.initials: KW
authors.lastname: Jauch
authors.forename: Christiane J
authors.initials: CJ
authors.lastname: Bruns
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology*; D008099:Liver / Q000601:surgery*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055815:Young Adult