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eComment: Surgery for pulmonary metastases of renal cell carcinoma. Video-assisted thoracoscopic or open procedure?

Theagenio Cancer Hospital, A. Simeonidi 2, 54007 Thessaloniki, Greece

Pulmonary resection for metastasis from renal cell carcinoma

We read with great interest the article by Fengshi Chen et al. regarding pulmonary resection for metastases from renal cell carcinoma [1] and we would like to congratulate the authors.

Nearly 20–25% of patients with renal cell carcinoma (RCC) have distant metastasis at presentation. Another 50% develop metastasis or local recurrence during follow-up after the treatment of the primary [2]. RCC can recur at any time after nephrectomy and usually metastasizes via venous and lymphatic routes.

We favor aggressive surgical excision for solitary synchronous or metachronous pulmonary metastatic lesions with postoperative adjuvant immunotherapy or immunochemotherapy. Our data count only six cases during the last five years with very good survival results.

On the basis of our findings during surgery for pulmonary metastatic disease, video-assisted thoracoscopic surgery is not recommended if curative resection is intended, due to insufficient palpation of the deflated lung. As a consequence there is a high risk of missing smaller lesions. These findings are supported by other studies [3] and this is a significant point for discussion.

Pulmonary metastasectomy for RCC in selected patients seems to be well justified in view of low perioperative mortality and morbidity rates and due to the lack of appropriate treatment alternatives. A large multicenter study is needed for determining technical and prognostic points.

	References

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1. Chen F, Fujinaga T, Shoji T, Miyahara R, Bando T, Okubo K, Hirata T, Date H. Pulmonary resection for metastasis from renal cell carcinoma. Interact CardioVasc Thorac Surg 2008;7:825–828.[Abstract/Free Full Text]
2. Cozzoli A, Milano S, Cancarini G, Zanotelli T, Cosciani Cunico S. Surgery of lung metastases in renal cell carcinoma. Br J Urol 1995;75:445–447.[Medline]
3. Piltz S, Meimarakis G, Wichmann MW, Hatz R, Schildberg FW, Fuerst H. Long-term results after pulmonary resection of renal cell carcinoma metastases. Ann Thorac Surg 2002;73:1082–1087.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Nikolaos Barbetakis Permission Requests Google Scholar Articles by Barbetakis, N. Articles by Tsilikas, C. PubMed PubMed Citation Articles by Barbetakis, N. Articles by Tsilikas, C. Related Collections Related Article