title: Twelve-year survival after multiple recurrences and repeated metastasectomies for renal cell carcinoma.
abstract: BACKGROUND
  Metastatic renal cell carcinoma (RCC) presents a therapeutic challenge for clinicians because of the unpredictable clinical course, resistance to chemotherapy or radiotherapy and the limited response to immunotherapy.
  
  
  METHODS
  We report a case of a 62-year-old woman who underwent nephrectomy for T4N0 RCC, clear cell type, Fuhrman grade 3/4 in 1999. The patient subsequently had multiple tumor recurrences.
  
  
  RESULTS
  The patient underwent eight metastasectomies, including multiple partial left nephrectomies, right adrenalectomy, a complete left nephrectomy, and distal pancreatectomy. She remains well and tumor free 12 years after initial diagnosis.
  
  
  CONCLUSIONS
  Repeated resections after initial metastasectomy can be carried out safely and provide long-term survival in selected patients with recurrent metastasis from RCC. The findings from our case indicate that close follow-up for the early detection of recurrence and complete resection of metastases can improve the results after repeated resection.
authors: Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA. juewang@unmc.edu
authors: Jue
authors: J
authors: Wang
authors: Geoffrey A
authors: GA
authors: Talmon
authors: Michael
authors: M
authors: Feloney
authors: Michael C
authors: MC
authors: Morris
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D059146:Metastasectomy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome