Metastatic renal cell carcinoma of the spine: surgical treatment and results

Abstract

Object. Renal cell carcinoma (RCC) is an aggressive malignancy that frequently metastasizes. When RCC metastasizes to the spine, significant pain and neurological dysfunction often follow. Because systemic therapy and radiotherapy have a limited effect in controlling spinal disease, surgery is frequently required; however, there are very few published series specifically addressing the role and benefits of the surgical treatment for this disease. The authors conducted a retrospective study to review their experience with the surgical treatment of metastatic RCC of the spine, paying particular attention to methodology and patient neurological status, pain relief, and survival. Methods. Between January 1993 and April 1999, 79 patients (63 men and 16 women patients; average age 55 years, range 16–82 years) underwent 107 spinal operations for metastatic RCC. Indications for surgery included disabling pain (94 [88%] of 107 procedures) and/or neurological dysfunction (55 [51%] of 107 procedures). The anatomical location and extent of tumor determined the choice of an anterior, posterior, or combined surgical approach. Internal fixation was performed in all but three patients. Preoperative embolization was required in approximately one half of the patients. Radiotherapy was performed in 40 patients prior to surgery, and immuno- and chemotherapy were administered in 70 patients either pre- or postoperatively. After an average follow-up duration of 15 months, 57 patients had died. Kaplan—Meier analysis revealed a median postoperative survival of 12.3 months. Significant pain reduction, as indicated by a visual analog pain scale, was achieved in 84 (89%) of the 94 cases presenting with disabling pain. Neurological improvement was seen in 36 (65%) of the 55 patients. The major morbidity and 30-day mortality rates were 15% (16 of 107 procedures) and 2% (two of 107 procedures), respectively. Conclusions. In selected patients with metastatic RCC of the spine, resection followed by stabilization can provide pain relief and neurological preservation or improvement.