- Design
- Retrospective single-institution 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 (p=0.02) for intralesional surgery
A single-institution retrospective series (JBJS, 7 October 2026) reviewed 105 patients with 133 surgically treated long-bone metastases from renal cell carcinoma between 2005 and 2022, comparing intralesional procedures such as curettage and fixation with resection and reconstruction.
Cumulative reoperation was similar (subdistribution HR 1.08, p=0.87). Reasons differed: pathological fracture and recurrence dominated after intralesional surgery, while wound infection featured after resection. Intralesional surgery was associated with higher mortality overall (HR 2.03, p=0.02), but not in patients with a solitary metastasis (HR 1.54, p=0.49).
The mortality difference likely reflects who gets each operation - intralesional surgery is often chosen for patients with more widespread disease. The finding argues against assuming that resection is always required to avoid failure, while keeping resection on the table for the patient with a solitary, potentially curable lesion.
- Consider resection and reconstruction for a solitary renal cell metastasis in a fit patient
- Accept intralesional fixation as reasonable where disease is widespread and recovery time matters
- Plan for heavy bleeding in renal cell metastases and consider preoperative embolisation
- Watch for pathological fracture and local recurrence after intralesional surgery
Why it matters
It questions the belief that renal cell metastases always need resection to avoid failure.
Don't overread it
The mortality gap reflects case selection as much as surgery; this cannot show resection improves survival.
The statistics, in plain English
The higher mortality after intralesional surgery is an association in a small, selected series; patients with more metastases are more likely to be offered the smaller operation. The solitary-metastasis subgroup is too small to show a difference either way.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for orthopaedics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free