Papel de la nefrectomía en el adenocarcinoma renal metastático: experiencia del Servicio de Urología del Hospital Juan Canalejo

objectives: we expose our experience in nephrectomy in metastatic renal cell carcinoma, and also show complications, evolution and survival of these patients. material and methods: we performe a retrospective review of renal cell carcinomaes treated at our service in the period between january 1st 1991 and december 31st 2002. we only studied those which presented in a metastatic pattern (31), and divide these in two groups: the ones which were nephrectomized and those which were not. we try to showw the diferences between the two groups in order of status performance (e.c.o.g.), associated morbidity and median survival. in the first group we also study complications of surgery and treatment that patients underwent. results: we performed nephrectomy in 19 cases, all of them e.c.o.g. 0-1. median postoperative stay was 12 days, and complication rate was 11.5%. of these patients, 45% underwent some tipe of systemic treatment, and median survival was 31 months. we didn′t performed nephrectomy in 12 patients, of which 9 were e.c.o.g. 2-3. asociated co-morbidity was higher in this group. only in three patients any treatment was offerted always with paliative reason. median survival was 3.8 months. conclusions: in those patients with good performance status this aproach does not represent more morbility nor mortality than in non- metastatic patients, and that is a cornerstone in their management. we also make a literature review in wich we see the last pathways in the managemente of these patients, and that show the needing for a conbined aproach both quirurgical and inmunotherapical. we have review with special interest the studie？s conclusions of swog and eortc groups.