title: Role of metastasectomy in metastatic renal cell carcinoma.
abstract: OBJECTIVE
  Management of patients with metastatic renal cell carcinoma is challenging and continues to be delivered in a multidisciplinary context. Even with the advent of systemic targeted therapy, complete remission with these new agents is rare using systemic therapy alone. Surgical resection of the primary tumor and metastatic deposits continues to play an important role in managing patients with metastatic renal cell carcinoma when aiming for complete remissions. To date, despite the lack of level 1 evidence, metastasectomy appears to prolong survival and achieve long-term cure in carefully selected patients. This review examines current evidence for the role of metastasectomy in renal cell carcinoma.
  
  
  RESULTS
  Studies continue to consistently support a benefit of complete metastasectomy for overall and cancer-specific survival at most sites for resection, with the exception of brain and bone, which tend to perform for symptomatic relief and palliation. Metastasectomy has not yet been examined in a randomized setting. The debate of survival benefit because of selection bias of patients or differences in tumor biology is relevant and has yet to be resolved in the literature. Clearly, careful patient selection remains paramount in optimizing survival benefit from metastasectomy.
  
  
  CONCLUSIONS
  Patients with isolated surgically resectable metastatic disease, with long disease-free intervals, and with good performance status are likely to benefit the most from metastasectomy.
authors.affiliation: Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Arun Z
authors.initials: AZ
authors.lastname: Thomas
authors.forename: Mehrad
authors.initials: M
authors.lastname: Adibi
authors.forename: Leonardo D
authors.initials: LD
authors.lastname: Borregales
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Jose A
authors.initials: JA
authors.lastname: Karam
mesh_terms: D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D059146:Metastasectomy / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome