[Is surgical treatment ever indicated in metastatic renal cell carcinoma and if so, based on which scientific rationale?]
BACKGROUND
Metastasis is a common event in renal cell carcinoma. Surgical resection of metastases may be feasible in two scenarios: aiming at palliation, which may be feasible due to reduced radiosensitivity of renal cell cancer, and aiming at prolonging survival, which may be feasible given the rather good prognosis of some patterns of metastasis.


OBJECTIVE
This review intends to reflect on current evidence for surgical resection of metastases in both scenarios. The literature was searched in PubMed and respective guidelines were reviewed.


CONCLUSIONS
Palliative resection is mainly feasible to control symptoms like spinal compression; adjuvant radiation is advisable. Resection is markedly feasible, however, for improvement of cancer-specific survival in probably all resectable patterns of metastasis-solitary, multiple, syn- and metachronous, and in all organs-provided complete resection can be achieved. A fairly good prognosis is seen in solitary pulmonary metastasis without concomitant hilar or mediastinal lymph node metastasis and a metachronous appearance following long recurrence-free survival after tumor nephrectomy; complete resection may be considered curative in certain cases. Neo- or adjuvant medical therapy or radiation is not established. In cases lacking complete resectability, stereotactic radiation may be considered as an alternative.
Klinik für Urologie Lehrstuhl der Universität Regensburg, Caritas-Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland. maximilian.burger@ukr.de.
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Burger
D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000066491:Clinical Decision-Making / Q000379:methods; D065426:Cytoreduction Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D009392:Nephrectomy / Q000401:mortality / Q000706:statistics & numerical data*; D015995:Prevalence; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome
Metastasectomy; Metastasis; Palliative care; Radiotherapy, adjuvant; Resection, palliative