Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades
Purpose Despite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative t...
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| Veröffentlicht in: | Langenbeck's archives of surgery 2020-02, Vol.405 (1), p.97-106 |
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| creator | Beetz, Oliver Söffker, Rabea Cammann, Sebastian Oldhafer, Felix Vondran, Florian W. R. Imkamp, Florian Klempnauer, Jürgen Kleine, Moritz |
| description | Purpose
Despite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative to surgery, therapeutical strategies in stage IV disease must be reevaluated.
Methods
This is a retrospective analysis of 40 patients undergoing hepatic resection of histologically confirmed RCC metastases at our institution between April 1993 and April 2017.
Results
The interval between nephrectomy for renal cell carcinoma and hepatic metastasectomy was 44.0 months (3.3–278.5). Liver resections of different extents were performed, including multivisceral resections. The median follow-up was 37.8 months (0.5–286.5). Tumor recurrence after resection of hepatic metastases occurred in 19 patients resulting in a median disease-free survival of 16.2 months (0.7–265.1) and a median overall survival of 37.8 months (0.5–286.5). Multivariable analysis identified multivisceral resection as an independent risk factor for disease-free and overall survival (
p
= 0.043 and
p
= 0.001, respectively). A longer interval between nephrectomy and hepatic metastasectomy was identified as an independent significant protective factor for overall survival (
p
|
| doi_str_mv | 10.1007/s00423-019-01852-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7036059</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2339001829</sourcerecordid><originalsourceid>FETCH-LOGICAL-c446t-22b4510042c357c349d7eccadfdee10767ffeaa3eb959ca291ee93503c4d383d3</originalsourceid><addsrcrecordid>eNp9kUtuFDEQhi1ERB5wARbISzYdbJd7eswCCUUhQYrEJqwtj10946jbbmxPyOw4A-KEnAQ3E0awQfJT9dfvcn2EvOTsnDPWvcmMSQEN46rOZSsa-YSccAltI2TLnx7OEo7Jac53jLFFp-QzcgxcwXIJcEK-Xz4UDA4d3eBkird0xGJyHWhLHHe0j4kmDGagFoe6mGR9iKP5-e1HwK_U5KkKM_WBFj9iprGnxaQ1lmpZNpjMtHtLDc0-rAdsLIaCieLDhMljsEjjfb2XTUKkDq1xmJ-To94MGV887mfk84fL24vr5ubT1ceL9zeNlXJRGiFW9ZdzCyy0nQWpXIe2OvQOkbNu0fU9GgO4Uq2yRiiOqKBlYKWDJTg4I-_2vtN2NaKbS0tm0FPyo0k7HY3X_0aC3-h1vNcdgwVrVTV4_WiQ4pct5qJHn-cumYBxm7UAUKySEbNU7KU2xZwT9odnONMzTL2HqStM_RumljXp1d8FHlL-0KsC2AtyDYU1Jn0Xt6myyv-z_QVTN7BM</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2339001829</pqid></control><display><type>article</type><title>Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Beetz, Oliver ; Söffker, Rabea ; Cammann, Sebastian ; Oldhafer, Felix ; Vondran, Florian W. R. ; Imkamp, Florian ; Klempnauer, Jürgen ; Kleine, Moritz</creator><creatorcontrib>Beetz, Oliver ; Söffker, Rabea ; Cammann, Sebastian ; Oldhafer, Felix ; Vondran, Florian W. R. ; Imkamp, Florian ; Klempnauer, Jürgen ; Kleine, Moritz</creatorcontrib><description>Purpose
Despite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative to surgery, therapeutical strategies in stage IV disease must be reevaluated.
Methods
This is a retrospective analysis of 40 patients undergoing hepatic resection of histologically confirmed RCC metastases at our institution between April 1993 and April 2017.
Results
The interval between nephrectomy for renal cell carcinoma and hepatic metastasectomy was 44.0 months (3.3–278.5). Liver resections of different extents were performed, including multivisceral resections. The median follow-up was 37.8 months (0.5–286.5). Tumor recurrence after resection of hepatic metastases occurred in 19 patients resulting in a median disease-free survival of 16.2 months (0.7–265.1) and a median overall survival of 37.8 months (0.5–286.5). Multivariable analysis identified multivisceral resection as an independent risk factor for disease-free and overall survival (
p
= 0.043 and
p
= 0.001, respectively). A longer interval between nephrectomy and hepatic metastasectomy was identified as an independent significant protective factor for overall survival (
p
< 0.001). Patients undergoing metastasectomy after introduction of sunitinib in Europe in 2006 (
n
= 15) showed a significantly longer overall survival (45.2 (9.1–111.0) versus 27.5 (0.5–286.52) months in the preceding era;
p
= 0.038).
Conclusion
Hepatic metastasectomy, including major and extended resections, on patients with metastasized renal cell carcinoma can be performed safely and may facilitate long-term survival. Due to significant morbidity and increased mortality, multivisceral resections must be weighed against other options, such as targeted therapy.</description><identifier>ISSN: 1435-2443</identifier><identifier>EISSN: 1435-2451</identifier><identifier>DOI: 10.1007/s00423-019-01852-4</identifier><identifier>PMID: 31938833</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Abdominal Surgery ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents - administration & dosage ; Carcinoma, Renal Cell - drug therapy ; Carcinoma, Renal Cell - secondary ; Carcinoma, Renal Cell - surgery ; Cardiac Surgery ; Female ; General Surgery ; Hepatectomy - methods ; Hepatectomy - mortality ; Humans ; Kaplan-Meier Estimate ; Kidney Neoplasms - drug therapy ; Kidney Neoplasms - pathology ; Kidney Neoplasms - surgery ; Liver Neoplasms - drug therapy ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Male ; Medicine ; Medicine & Public Health ; Metastasectomy - methods ; Metastasectomy - mortality ; Middle Aged ; Models, Theoretical ; Molecular Targeted Therapy ; Nephrectomy ; Original ; Original Article ; Prognosis ; Retrospective Studies ; Risk Assessment ; Sunitinib - therapeutic use ; Thoracic Surgery ; Traumatic Surgery ; Vascular Surgery</subject><ispartof>Langenbeck's archives of surgery, 2020-02, Vol.405 (1), p.97-106</ispartof><rights>The Author(s) 2020</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c446t-22b4510042c357c349d7eccadfdee10767ffeaa3eb959ca291ee93503c4d383d3</citedby><cites>FETCH-LOGICAL-c446t-22b4510042c357c349d7eccadfdee10767ffeaa3eb959ca291ee93503c4d383d3</cites><orcidid>0000-0002-4515-3209</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00423-019-01852-4$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00423-019-01852-4$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,776,780,881,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31938833$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Beetz, Oliver</creatorcontrib><creatorcontrib>Söffker, Rabea</creatorcontrib><creatorcontrib>Cammann, Sebastian</creatorcontrib><creatorcontrib>Oldhafer, Felix</creatorcontrib><creatorcontrib>Vondran, Florian W. R.</creatorcontrib><creatorcontrib>Imkamp, Florian</creatorcontrib><creatorcontrib>Klempnauer, Jürgen</creatorcontrib><creatorcontrib>Kleine, Moritz</creatorcontrib><title>Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades</title><title>Langenbeck's archives of surgery</title><addtitle>Langenbecks Arch Surg</addtitle><addtitle>Langenbecks Arch Surg</addtitle><description>Purpose
Despite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative to surgery, therapeutical strategies in stage IV disease must be reevaluated.
Methods
This is a retrospective analysis of 40 patients undergoing hepatic resection of histologically confirmed RCC metastases at our institution between April 1993 and April 2017.
Results
The interval between nephrectomy for renal cell carcinoma and hepatic metastasectomy was 44.0 months (3.3–278.5). Liver resections of different extents were performed, including multivisceral resections. The median follow-up was 37.8 months (0.5–286.5). Tumor recurrence after resection of hepatic metastases occurred in 19 patients resulting in a median disease-free survival of 16.2 months (0.7–265.1) and a median overall survival of 37.8 months (0.5–286.5). Multivariable analysis identified multivisceral resection as an independent risk factor for disease-free and overall survival (
p
= 0.043 and
p
= 0.001, respectively). A longer interval between nephrectomy and hepatic metastasectomy was identified as an independent significant protective factor for overall survival (
p
< 0.001). Patients undergoing metastasectomy after introduction of sunitinib in Europe in 2006 (
n
= 15) showed a significantly longer overall survival (45.2 (9.1–111.0) versus 27.5 (0.5–286.52) months in the preceding era;
p
= 0.038).
Conclusion
Hepatic metastasectomy, including major and extended resections, on patients with metastasized renal cell carcinoma can be performed safely and may facilitate long-term survival. Due to significant morbidity and increased mortality, multivisceral resections must be weighed against other options, such as targeted therapy.</description><subject>Abdominal Surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Carcinoma, Renal Cell - drug therapy</subject><subject>Carcinoma, Renal Cell - secondary</subject><subject>Carcinoma, Renal Cell - surgery</subject><subject>Cardiac Surgery</subject><subject>Female</subject><subject>General Surgery</subject><subject>Hepatectomy - methods</subject><subject>Hepatectomy - mortality</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Kidney Neoplasms - drug therapy</subject><subject>Kidney Neoplasms - pathology</subject><subject>Kidney Neoplasms - surgery</subject><subject>Liver Neoplasms - drug therapy</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastasectomy - methods</subject><subject>Metastasectomy - mortality</subject><subject>Middle Aged</subject><subject>Models, Theoretical</subject><subject>Molecular Targeted Therapy</subject><subject>Nephrectomy</subject><subject>Original</subject><subject>Original Article</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Sunitinib - therapeutic use</subject><subject>Thoracic Surgery</subject><subject>Traumatic Surgery</subject><subject>Vascular Surgery</subject><issn>1435-2443</issn><issn>1435-2451</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><recordid>eNp9kUtuFDEQhi1ERB5wARbISzYdbJd7eswCCUUhQYrEJqwtj10946jbbmxPyOw4A-KEnAQ3E0awQfJT9dfvcn2EvOTsnDPWvcmMSQEN46rOZSsa-YSccAltI2TLnx7OEo7Jac53jLFFp-QzcgxcwXIJcEK-Xz4UDA4d3eBkird0xGJyHWhLHHe0j4kmDGagFoe6mGR9iKP5-e1HwK_U5KkKM_WBFj9iprGnxaQ1lmpZNpjMtHtLDc0-rAdsLIaCieLDhMljsEjjfb2XTUKkDq1xmJ-To94MGV887mfk84fL24vr5ubT1ceL9zeNlXJRGiFW9ZdzCyy0nQWpXIe2OvQOkbNu0fU9GgO4Uq2yRiiOqKBlYKWDJTg4I-_2vtN2NaKbS0tm0FPyo0k7HY3X_0aC3-h1vNcdgwVrVTV4_WiQ4pct5qJHn-cumYBxm7UAUKySEbNU7KU2xZwT9odnONMzTL2HqStM_RumljXp1d8FHlL-0KsC2AtyDYU1Jn0Xt6myyv-z_QVTN7BM</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Beetz, Oliver</creator><creator>Söffker, Rabea</creator><creator>Cammann, Sebastian</creator><creator>Oldhafer, Felix</creator><creator>Vondran, Florian W. R.</creator><creator>Imkamp, Florian</creator><creator>Klempnauer, Jürgen</creator><creator>Kleine, Moritz</creator><general>Springer Berlin Heidelberg</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4515-3209</orcidid></search><sort><creationdate>20200201</creationdate><title>Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades</title><author>Beetz, Oliver ; Söffker, Rabea ; Cammann, Sebastian ; Oldhafer, Felix ; Vondran, Florian W. R. ; Imkamp, Florian ; Klempnauer, Jürgen ; Kleine, Moritz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c446t-22b4510042c357c349d7eccadfdee10767ffeaa3eb959ca291ee93503c4d383d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Carcinoma, Renal Cell - drug therapy</topic><topic>Carcinoma, Renal Cell - secondary</topic><topic>Carcinoma, Renal Cell - surgery</topic><topic>Cardiac Surgery</topic><topic>Female</topic><topic>General Surgery</topic><topic>Hepatectomy - methods</topic><topic>Hepatectomy - mortality</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Kidney Neoplasms - drug therapy</topic><topic>Kidney Neoplasms - pathology</topic><topic>Kidney Neoplasms - surgery</topic><topic>Liver Neoplasms - drug therapy</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastasectomy - methods</topic><topic>Metastasectomy - mortality</topic><topic>Middle Aged</topic><topic>Models, Theoretical</topic><topic>Molecular Targeted Therapy</topic><topic>Nephrectomy</topic><topic>Original</topic><topic>Original Article</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Sunitinib - therapeutic use</topic><topic>Thoracic Surgery</topic><topic>Traumatic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Beetz, Oliver</creatorcontrib><creatorcontrib>Söffker, Rabea</creatorcontrib><creatorcontrib>Cammann, Sebastian</creatorcontrib><creatorcontrib>Oldhafer, Felix</creatorcontrib><creatorcontrib>Vondran, Florian W. R.</creatorcontrib><creatorcontrib>Imkamp, Florian</creatorcontrib><creatorcontrib>Klempnauer, Jürgen</creatorcontrib><creatorcontrib>Kleine, Moritz</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Langenbeck's archives of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Beetz, Oliver</au><au>Söffker, Rabea</au><au>Cammann, Sebastian</au><au>Oldhafer, Felix</au><au>Vondran, Florian W. R.</au><au>Imkamp, Florian</au><au>Klempnauer, Jürgen</au><au>Kleine, Moritz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades</atitle><jtitle>Langenbeck's archives of surgery</jtitle><stitle>Langenbecks Arch Surg</stitle><addtitle>Langenbecks Arch Surg</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>405</volume><issue>1</issue><spage>97</spage><epage>106</epage><pages>97-106</pages><issn>1435-2443</issn><eissn>1435-2451</eissn><abstract>Purpose
Despite the introduction of novel targeted therapies on patients with renal cell carcinoma, syn- and metachronous metastases (including hepatic lesions) are observed frequently and significantly influence patient survival. With introduction of targeted therapies as an effective alternative to surgery, therapeutical strategies in stage IV disease must be reevaluated.
Methods
This is a retrospective analysis of 40 patients undergoing hepatic resection of histologically confirmed RCC metastases at our institution between April 1993 and April 2017.
Results
The interval between nephrectomy for renal cell carcinoma and hepatic metastasectomy was 44.0 months (3.3–278.5). Liver resections of different extents were performed, including multivisceral resections. The median follow-up was 37.8 months (0.5–286.5). Tumor recurrence after resection of hepatic metastases occurred in 19 patients resulting in a median disease-free survival of 16.2 months (0.7–265.1) and a median overall survival of 37.8 months (0.5–286.5). Multivariable analysis identified multivisceral resection as an independent risk factor for disease-free and overall survival (
p
= 0.043 and
p
= 0.001, respectively). A longer interval between nephrectomy and hepatic metastasectomy was identified as an independent significant protective factor for overall survival (
p
< 0.001). Patients undergoing metastasectomy after introduction of sunitinib in Europe in 2006 (
n
= 15) showed a significantly longer overall survival (45.2 (9.1–111.0) versus 27.5 (0.5–286.52) months in the preceding era;
p
= 0.038).
Conclusion
Hepatic metastasectomy, including major and extended resections, on patients with metastasized renal cell carcinoma can be performed safely and may facilitate long-term survival. Due to significant morbidity and increased mortality, multivisceral resections must be weighed against other options, such as targeted therapy.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>31938833</pmid><doi>10.1007/s00423-019-01852-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-4515-3209</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Abdominal Surgery Adult Aged Aged, 80 and over Antineoplastic Agents - administration & dosage Carcinoma, Renal Cell - drug therapy Carcinoma, Renal Cell - secondary Carcinoma, Renal Cell - surgery Cardiac Surgery Female General Surgery Hepatectomy - methods Hepatectomy - mortality Humans Kaplan-Meier Estimate Kidney Neoplasms - drug therapy Kidney Neoplasms - pathology Kidney Neoplasms - surgery Liver Neoplasms - drug therapy Liver Neoplasms - secondary Liver Neoplasms - surgery Male Medicine Medicine & Public Health Metastasectomy - methods Metastasectomy - mortality Middle Aged Models, Theoretical Molecular Targeted Therapy Nephrectomy Original Original Article Prognosis Retrospective Studies Risk Assessment Sunitinib - therapeutic use Thoracic Surgery Traumatic Surgery Vascular Surgery |
| title | Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades |
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