Resection of Renal Cell Cancer Metastases: Where Do We Stand in 2008?

Metastatic renal cell cancer is a highly malignant disease without established curative treatment. Nephrectomy for the primary tumour, whenever possible, is still regarded necessary because evidence suggests that it may lead to moderate survival benefit. Surgery for metastases can be debated but accumulated evidence from many studies, although retrospective in character, shows that aggressive removal of all resectable metastases improves survival figures compared with no surgery. The results are best in case of solitary lung metastases, where 5-yr survival rates in the range of 50% have been reported. Also patients with good prognostic signs and surgically resected solitary metastases in other organs may survive >5 yr. In this review cytoreductive nephrectomy is discussed briefly and recent reports on the surgical treatment of metastases in the most common locations in more detail. It is not known yet whether the era of targeted medical treatments will have a significant impact on the surgical treatment policy, eventually by changing the order of treatments or even diminishing the need for surgery.