Aggressive treatment of metastatic renal cancer.

Radical nephrectomy and excision of metastases were performed in 21 patients with metastatic renal cell carcinoma. Followup was 12 years. Eight patients had metastases at the time of diagnosis and survived an average of 54 months, with 50 per cent alive 5 years postoperatively. Metastases developed after nephrectomy for localized disease in 13 patients. After extirpation of the secondary lesions these 13 patients survived an average of 38 months and 25 per cent were alive at 5 years. Survival varied with the length of time free of disease. Patients in whom metastases developed later than 2 years after nephrectomy survived 55 months compared to only 22 months for those in whom metastases developed earlier. Survival also was influenced by tumor aggressiveness (reflected by prognostic index number) and completeness of surgical excision of the secondary lesion.