EXTIRPATIVE TREATMENT OF RENAL METASTASES IN THE SPINE

Abstract

Introduction: There is increasing evidence that surgical treatment in tumour surgery can influence survival times. Renal cell carcinoma can lead to single or few sites of metastasis that are amenable to extirpative surgery with reconstruction in the spine¹. Such treatment can also be beneficial to improve quality of surviving years.

Methods: Retrospective cohort study of 10 consecutive patients treated for spinal metastatic renal cell carcinoma. Case note review and patient or general practitioner contact was used to ascertain number of metastases, treatment given, survival time from diagnosis and survival time from surgery. All primary tumours were treated with nephrectomy.

Results: Of the 10 patients, 6 had extirpative treatment, while 4 had palliative surgery including decompression of the neural elements. Patients treated with extirpative surgery to spinal metastases from a renal cell carcinoma primary had a significantly longer survival time from surgery to those treated with palliative decompressions alone. There were no significant differences in age or time from diagnosis to surgical treatment between groups. There were no cases of operative mortality, but significant intraoperative bleeding was encountered in extirpative treatment of the affected vertebra, despite preoperative embolisation.

Discussion: The role of surgical treatment in metastasis to the spine is of current interest. Our results have shown significant survival times are possible with extirpative treatment of renal metastases. Whilst this may not apply directly to metastases from other primary tumours, careful selection of cases and co-operation between spinal surgeons and oncologists is important to ensure maximal quality and length of survival for these patients. These cases are surgically challenging, and care is required to minimise and anticipate blood loss.