title: Retrospective survival analysis of 237 consecutive patients with multiple pulmonary metastases from advanced renal cell carcinoma exclusively resected by a 1318-nm laser.
abstract: OBJECTIVE
  Despite the introduction of new target drugs to treat pulmonary metastatic renal cell carcinoma (mRCC), complete surgical resection still generates significantly longer survival. We analysed the survival outcome for patients with pulmonary mRCC after extended laser metastasectomy with up to 110 metastases and systematic lymphadenectomy to assess the utility and value of laser resection in the respective patient groups even with high number of metastases.
  
  
  METHODS
  Between 1996 and 2012, 237 patients (150 men, 87 women) underwent curative intended pulmonary laser metastasectomy of mRCC. A total of 2996 metastases (range: 1-110) were resected. Kaplan-Meier analysis was performed to assess overall survival in all 237 patients and for sub-groups. Multivariate analysis of prognostic factors was performed using Cox regression models.
  
  
  RESULTS
  Two hundred and eight patients with R0-resection (88%) had 5-year overall survival rate and median overall survival of 54% and 69 months, respectively, significantly better than 7% and 19 months in those with incomplete resections (log-rank P < 0.00001). A mean of 13 metastases per patient were resected. Five-year survival for patients with 1, 2-5, 6-9, 10-29 or 30-110 metastases resected was 62, 59, 60, 43 and 40%, respectively. In multivariate Cox-regression of all 237 patients, only completeness of resection (P < 0.0001) and number of metastases (P = 0.0029) were independent factors.
  
  
  CONCLUSIONS
  If complete resection is achieved, laser resection can remove even high numbers of metastases with considerable and comparable long-term survival known from previous reports. This tissue-saving technique allows repeated resections in case of recurrence.
authors.affiliation: Department of Thoracic and Vascular Surgery, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Baier
authors.affiliation: Department of Thoracic and Vascular Surgery, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany kern@fachkrankenhaus-coswig.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kern
authors.affiliation: Institute for Medical Informatics and Biometry, Medical Faculty Carl-Gustav Carus, Technische Universität Dresden, Dresden, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Kaderali
authors.affiliation: Department of Thoracic and Vascular Surgery, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
authors.forename: Beata
authors.initials: B
authors.lastname: Bis
authors.affiliation: Department of Pulmonary Diseases, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Koschel
authors.affiliation: Department of Thoracic and Vascular Surgery, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Rolle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D053685:Laser Therapy / Q000401:mortality; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008197:Lymph Node Excision; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: 1318 nm laser; Pulmonary metastasectomy; Renal cell carcinoma; Survival analysis