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Metastasectomy, intralesional resection, or stabilization only in the treatment of bone metastases from renal cell carcinoma
Author(s) -
Langerhuizen David W.G.,
Janssen Stein J.,
van der Vliet Quirine M.J.,
Raskin Kevin A.,
Ferrone Marco L.,
Hornicek Francis J.,
Schwab Joseph H.,
LozanoCalderón Santiago A.
Publication year - 2016
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24284
Subject(s) - medicine , metastasectomy , curettage , renal cell carcinoma , surgery , surgical margin , survival rate , metastasis , overall survival , retrospective cohort study , significant difference , urology , resection , oncology , cancer
Background The mainstay of treatment for bone metastases from renal cell carcinoma is surgery. We assessed if there was a difference in local recurrence, reoperation, and survival between patients who underwent metastasectomy, intralesional curettage, or stabilization only for renal cell carcinoma metastasis to the appendicular skeleton, and if there was a difference in these outcomes based on margin status. Methods This retrospective study included 183 patients; 48% underwent metastasectomy (n = 88, margins: 64 negative; 20 positive; 4 unclear), 30% intralesional curettage (n = 54), and 22% stabilization only (n = 41). Results The recurrence rate differed and was highest after stabilization only (39%), followed by intralesional curettage (22%), and metastasectomy (12%) ( P = 0.003). However, we found no difference in reoperation rate ( P = 0.847). Survival was better in patients who underwent metastasectomy ( P = 0.020). The recurrence rate was lower in patients who had a negative margin (5%) as compared to those with a positive margin (26%) ( P < 0.001). However, we found no difference in reoperation rate ( P = 0.97). Negative margins showed better survival ( P < 0.001). Conclusions Our findings emphasize the importance of obtaining negative margins in patients with a good life expectancy, as lower recurrence rate can be attained at a not significant additional risk for reoperation, with a potential impact on survival. J. Surg. Oncol. 2016;114:237–245 . © 2016 Wiley Periodicals, Inc.