Surgery of lung metastases in renal cell carcinoma

OBJECTIVE: To examine the impact on survival of pulmonary resection in the treatment of renal cell carcinoma that has metastasized to the lung. PATIENTS AND METHODS: From June 1986 to July 1991, 19 patients were submitted to synchronous or asynchronous lung metastasectomy. Histological examination confirmed the presence of lung metastases from renal cell carcinoma in 16 cases (six synchronous and 10 asynchronous with a mean disease-free interval of 23 months). In the other three cases, histological examination revealed tuberculomas, chondroid hamartoma and foci of anthracosis. RESULTS: To date, among the six patients with synchronous lung metastases, three have died, two are progressing and one has no evident disease after a mean survival of 24 months. Among the 10 patients who underwent surgical resection of metachronous lung metastases, one has died, three are progressing and six have no evident disease (mean survival time, 43 months). CONCLUSION: While the presence of synchronous lung metastases is an unfavourable prognostic factor even after surgical removal (five out of six patients died or are in progression shortly after metastasectomy), the results after surgery of asynchronous lung metastases are encouraging, although the real efficacy of this treatment is still to be confirmed.