title: Outcomes Following Complete Surgical Metastasectomy for Patients with Metastatic Renal Cell Carcinoma: A Systematic Review and Meta-Analysis.
abstract: The benefit of complete surgical metastasectomy for patients with metastatic renal cell carcinoma remains controversial due to limited outcome data. We performed a systematic review and meta-analysis to determine whether complete surgical metastasectomy confers a survival benefit compared to incomplete or no metastasectomy for patients with metastatic renal cell carcinoma.
  
  
  
  Ovid Embase®, MEDLINE®, Cochrane and Scopus® databases were searched for studies evaluating complete surgical metastasectomy for metastatic renal cell carcinoma through January 19, 2016. Only comparative studies reporting adjusted hazard ratios (aHRs) for all cause mortality of incomplete surgical metastasectomy vs complete surgical metastasectomy were included in the analysis. Generic inverse variance with random effects models was used to determine the pooled aHR. Risk of bias was assessed with the Newcastle-Ottawa Scale.
  
  
  
  Eight published cohort studies with a low or moderate potential for bias were included in the final analysis. The studies reported on a total of 2,267 patients (958 undergoing complete surgical metastasectomy and 1,309 incomplete surgical metastasectomy). Median overall survival ranged between 36.5 and 142 months for those undergoing complete surgical metastasectomy, compared to 8.4 to 27 months for incomplete surgical metastasectomy. Complete surgical metastasectomy was associated with a reduced risk of all cause mortality compared with incomplete surgical metastasectomy (pooled aHR 2.37, 95% CI 2.03-2.87, p <0.001), with low heterogeneity (I2= 0%). Complete surgical metastasectomy remained independently associated with a reduction in mortality across a priori subgroup and sensitivity analyses, and regardless of whether we adjusted for performance status.
  
  
  
  Complete surgical metastasectomy for metastatic renal cell carcinoma is associated with improved survival compared with incomplete surgical metastasectomy based on meta-analysis of observational data. Consideration should be given to performing complete surgical metastasectomy, when technically feasible, in patients with metastatic renal cell carcinoma who are surgical candidates.
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: Harras B
authors.initials: HB
authors.lastname: Zaid
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: William P
authors.initials: WP
authors.lastname: Parker
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: Nida S
authors.initials: NS
authors.lastname: Safdar
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: Boris
authors.initials: B
authors.lastname: Gershman
authors.affiliation: Mayo Clinic Libraries, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.affiliation: Center for the Science of Health Care Delivery, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Boorjian
authors.affiliation: Department of Oncology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Costello
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota.
authors.forename: R Houston
authors.initials: RH
authors.lastname: Thompson
authors.affiliation: Department of Urology, Mayo Clinic and Medical School, Rochester, Minnesota. Electronic address: Leibovich.Bradley@mayo.edu.
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Leibovich
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009362:Neoplasm Metastasis / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: carcinoma; metastasectomy; neoplasm metastasis; renal cell