title: Long-term results of surgical resection for pulmonary metastasis from renal cell carcinoma: a 25-year single-institution experience.
abstract: OBJECTIVE
  Despite the report of new treatment options, surgery remains the best treatment for pulmonary metastases from renal cell carcinoma (RCC). Repeat resection is also an effective means for recurrent pulmonary metastases. The aim of the present study was to define the prognostic factors for survival after pulmonary metastasectomy from RCC based on a 25-year single-centre experience.
  
  
  METHODS
  Between 1973 and 2008, 59 thoracotomies on 48 patients (38 men, 10 women) were performed in our hospital. Repeat resections were performed in eight patients. The clinicopathological and surgical data of these patients obtained from the medical records were analysed. The time interval between lung resection and death, or latest follow-up, ranged from 3 to 177 months (median 39 months). Survival analysis was conducted by the Kaplan-Meier method and log-rank test. Multivariate analysis was performed using the Cox multivariate proportional hazard model.
  
  
  RESULTS
  The cumulative 3-, 5- and 10-year survival rates were 60%, 47% and 18%, respectively. Multivariate analysis identified disease-free interval (DFI) (≥ 2 years) and complete resection as significant prognostic factors for survival. Among eight patients, who underwent repeat resection, two remain alive with no evidence of disease. These two patients had long DFI and long DFI-2 (time from first pulmonary metastasectomy to diagnosis of recurrent pulmonary metastasis).
  
  
  CONCLUSIONS
  The results showed that (1) surgical resection of pulmonary metastasis from RCC has a favourable outcome in selected patients, (2) DFI and completeness of resection are prognostic markers for survival after pulmonary metastasectomy and (3) repeat lung resection for metastatic RCC is a safe procedure that provides satisfactory patient outcomes.
authors.affiliation: Department of Thoracic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan. rkanzaki@tj8.so-net.ne.jp
authors.forename: Ryu
authors.initials: R
authors.lastname: Kanzaki
authors.forename: Masahiko
authors.initials: M
authors.lastname: Higashiyama
authors.forename: Ayako
authors.initials: A
authors.lastname: Fujiwara
authors.forename: Toshiteru
authors.initials: T
authors.lastname: Tokunaga
authors.forename: Jun
authors.initials: J
authors.lastname: Maeda
authors.forename: Jiro
authors.initials: J
authors.lastname: Okami
authors.forename: Kazuo
authors.initials: K
authors.lastname: Nishimura
authors.forename: Ken
authors.initials: K
authors.lastname: Kodama
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D016896:Treatment Outcome