Surgical Treatment of Metastatic Renal Cell Carcinoma of the Spine

Ziya J. Gokaslan, MD Robert Jackson, MD (Houston, TX)

Metastatic Renal Cell Carcinoma of the Spine:

Results and Outcome Following Surgical Treatment Renal Cell Carcinoma (RCC) is an aggressive malignancy that frequently metastasizes. When RCC metastasizes to the spine, significant pain and neurological dysfunction often follow. We have retrospectively reviewed our experience with the surgical treatment of metastatic RCC of the spine, paying particular attention to method, neurological status, pain relief, and survival. Between January 1993 and June 1999, 79 patients (63 male, 16 female; average age 55 years, range 16–82) underwent 106 spinal operations for metastatic RCC. Indications for surgery included disabling pain (92/106 procedures = 87%) and/or neurological dysfunction (59/106 procedures = 55%). Anatomic location and extent of tumor determined anterior, posterior or combined surgical approach. Internal fixation was performed in all but 3 patients. Preoperative, endovascular tumor embolization was thought to reduce intraoperative blood loss, but was associated with significant complications. Radiotherapy was performed in 40 patients prior to surgery, and immuno/chemotherapy was used in 70 patients either pre– or postoperatively. After an average follow–up duration of 11.1 months, 34 patients had expired. Kaplan–Meier analysis revealed a median survival of 13 months following surgery. Significant pain reduction as noted by a visual analog pain scale was achieved in 92% (85/92). Neurological improvement was seen in 59% (35/59) of patients. Major morbidity and mortality occurred in 23% (18/79) and 2.5% (2/79) of patients, respectively. This included increased neurological dysfunction in three patients; however, these patients remained ambulatory. In selected patients with metastatic RCC of the spine, surgical resection followed by stabilization can provide pain relief and neurological preservation or improvement.