title: Partial nephrectomy in the setting of metastatic renal cell carcinoma.
abstract: OBJECTIVE
  Cytoreductive nephrectomy remains the standard of care for appropriately selected patients with metastatic renal cell carcinoma. Although the role of partial nephrectomy is well accepted in patients with localized disease, limited data are available on partial nephrectomy in the metastatic setting. We identified the indications for and outcomes of partial nephrectomy in the setting of metastatic renal cell carcinoma with particular attention to partial nephrectomy subgroups.
  
  
  METHODS
  We analyzed data on a consecutive cohort of 33 patients with metastatic renal cell carcinoma who underwent partial nephrectomy at a single institution between 1996 and 2011. Nonparametric statistics were used to compare partial nephrectomy subgroups. Overall survival was estimated using the Kaplan-Meier method and survival functions were compared using the log rank test.
  
  
  RESULTS
  At presentation 8 patients had bilateral synchronous renal masses, 20 had a metachronous contralateral renal mass and 5 had a unilateral renal mass. A total of 22 patients (67%) died of disease a median of 27 months postoperatively. Patients who underwent partial nephrectomy for a metachronous contralateral renal mass and a renal mass 4 cm or less had the best overall survival (61 and 42 months, respectively). Median overall survival in patients with vs without metastatic disease at original diagnosis was 27 vs 63 months (p = 0.003).
  
  
  CONCLUSIONS
  Our findings suggest that metastasis at the original diagnosis and the timing of presentation of the partial nephrectomy index lesion have an important role in survival. These factors should be considered when determining which patients would benefit from partial nephrectomy in the setting of metastatic renal cell carcinoma.
authors: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Kara N
authors: KN
authors: Babaian
authors: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Megan M
authors: MM
authors: Merrill
authors: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Surena
authors: S
authors: Matin
authors: Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Pheroze
authors: P
authors: Tamboli
authors: Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Nizar M
authors: NM
authors: Tannir
authors: Department of Genitourinary Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Eric
authors: E
authors: Jonasch
authors: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas.
authors: Christopher G
authors: CG
authors: Wood
authors: Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, Texas. Electronic address: JAKaram@mdanderson.org.
authors: Jose A
authors: JA
authors: Karam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies
keywords: carcinoma; diagnosis; kidney; neoplasm metastasis; nephrectomy; renal cell