Advanced-stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection

Abstract

Objective: To examine the effect of radical nephrectomy (RN) with adjacent organ and structure resection on survival, as invasion of adjacent organs in patients with renal cell carcinoma (RCC) is rare.

Patients and methods: After institutional review board approval, we reviewed our database and statistically analysed of patients with pathological stage T3 or T4 RCC who had RN and resection of a contiguous organ or structure.

Results: We identified 38 patients of 2464 (1.5%) who had RN with adjacent organ or structure resection. The median (interquartile range) size of the mass was 11 (8-14) cm, and the follow-up 13 (5-33) months. Most patients (68%) were pT4 stage and had conventional clear cell carcinoma (95%). Fourteen patients (37%) had positive surgical margins. The liver (10) was the most commonly resected adjacent organ or structure. Only one patient remains alive with no evidence of disease at 5 years, while three are currently alive with disease. Overall, 34 of 38 patients (90%) ultimately died from disease at a median (range) of 11.7 (5.4-29.2) months after surgical resection. The surgical margin status was the only statistically significant factor for recurrence and death (P = 0.006).

Conclusions: The prognosis for patients with advanced RCC and adjacent organ or structure involvement is extremely poor and similar to that of patients with metastatic disease. These patients should be thoroughly counselled about the impact of surgical management and considered for entry into neoadjuvant or adjuvant clinical trials with new targeted systemic agents.

Figures 1a and 1b

Figure 1a Kaplan Meier Overall Survival Figure 1b Kaplan Meier Overall Survival According to Surgical Margin Status.

Figures 1a and 1b

Figure 1a Kaplan Meier Overall Survival Figure 1b Kaplan Meier Overall Survival According to Surgical Margin Status.

Figure 2

Pre-operative CT demonstrating extensive tumor with local invasion into the liver. This patient is currently alive without evidence of disease.