title: A multi-institution analysis of outcomes of liver-directed surgery for metastatic renal cell cancer.
abstract: OBJECTIVE
  Management of liver metastasis (LM) from a non-colorectal, non-neuroendocrine primary carcinoma remains controversial. Few data exist on the management of hepatic metastasis from primary renal cell carcinoma (RCC). This study sought to determine the safety and efficacy of surgery for RCC LM.
  
  
  METHODS
  A total of 43 patients who underwent surgery for RCC hepatic metastasis between 1994 and 2011 were identified in a multi-institution hepatobiliary database. Clinicopathologic, operative and outcome data were collected and analysed.
  
  
  RESULTS
  Mean patient age was 62.4 years and most patients (67.4%) were male. The mean tumour size of the primary RCC was 6.9 cm and most tumours (72.1%) were designated as clear cell carcinoma. Nine patients (20.9%) presented with synchronous LM. Among the patients with metachronous disease, the median time from diagnosis of the primary RCC to treatment of LM was 17.2 months (range: 2.1-189.3 months). The mean size of the RCC LM was 4.0 cm and most patients (55.8%) had a solitary metastasis. Most patients (86.0%) underwent a minor resection (up to three segments). Final pathology showed margin status to be negative (R0) in 95.3% of patients. Postoperative morbidity was 23.3% and there was one perioperative death. A total of 69.8% of patients received perioperative chemotherapy. Overall 3-year survival was 62.1%. Three-year recurrence-free survival was 27.3% and the median length of recurrence-free survival was 15.5 months.
  
  
  CONCLUSIONS
  Resection of RCC hepatic metastasis is safe and is associated with low morbidity and near-zero mortality. Although recurrence occurs in up to 50% of patients, resection can be associated with long-term survival in a well-selected subset of patients.
authors: Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
authors: Ioannis
authors: I
authors: Hatzaras
authors: Ana L
authors: AL
authors: Gleisner
authors: Carlo
authors: C
authors: Pulitano
authors: Charbel
authors: C
authors: Sandroussi
authors: Kenzo
authors: K
authors: Hirose
authors: Omar
authors: O
authors: Hyder
authors: Christopher L
authors: CL
authors: Wolfgang
authors: Luca
authors: L
authors: Aldrighetti
authors: Michael
authors: M
authors: Crawford
authors: Michael A
authors: MA
authors: Choti
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D000368:Aged; D015142:Baltimore; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000009:adverse effects / Q000401:mortality; D008875:Middle Aged; D009517:New South Wales; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome