- Design
- Retrospective single-centre cohort
- Population
- 105 patients with 133 renal cell carcinoma long-bone metastases
- Primary outcome
- Reoperation and overall survival
- Effect
- Reoperation sHR 1.08 (p = 0.87); mortality HR 2.03 overall, 1.54 (NS) for solitary metastasis
A single-centre retrospective review in JBJS (7 October) included 105 patients with 133 renal cell carcinoma metastases in long bones treated surgically between 2005 and 2022, either by intralesional procedures such as curettage and fixation or by resection and reconstruction.
The cumulative incidence of reoperation did not differ between approaches (subdistribution HR 1.08, p = 0.87). Intralesional surgery was associated with higher mortality overall (HR 2.03), but not in patients with a solitary metastasis (HR 1.54, not significant). Reoperation after intralesional surgery was more often for pathological fracture.
The mortality difference most likely reflects selection: patients with more widespread disease are more often offered the smaller operation. For a solitary renal metastasis in a fit patient, resection remains a reasonable aim; for others, intralesional fixation did not carry more reoperations.
- Discuss renal cell carcinoma bone metastases in a multidisciplinary team before choosing resection or intralesional surgery.
- Consider resection and reconstruction for a solitary metastasis in a patient with good prognosis.
- Consider preoperative embolisation for renal metastases, which are often highly vascular.
- Plan for the risk of pathological fracture after intralesional procedures.
Why it matters
It questions whether the bigger operation should be routine for every renal metastasis.
Don't overread it
The higher mortality after intralesional surgery is likely confounded by sicker patients receiving it.
The statistics, in plain English
A subdistribution hazard ratio of 1.08 accounts for patients dying before they could need reoperation, and shows no difference. The solitary-metastasis subgroup is small, so the absence of a mortality difference there is uncertain.
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