Introduction: Renal cell carcinoma (RCC) frequently metastasizes to the vertebral column and causes debilitating pain or neurologic dysfunction. These lesions are often resistant to chemo-, immuno-, and radiation therapies, and require surgery for treatment. The authors conducted a retrospective review of all patients with spinal metastases of RCC treated with surgery at a single institution over a twelve year period.
Methods: Records of all patients undergoing spinal surgery for metastatic disease at a single institution between January 2000 and December 2011 were reviewed. Thirty patients were identified who had spinal surgery for metastatic RCC. Records were retrospectively reviewed for pre-operative disease and functional status, adjuvant treatments, operative variables, and survival. Statistical calculations, including Kaplan-Meier estimates and log-rank test for univariate analysis, were performed with R version 2.15.12 (The R Foundation for Statistical Computing, 2012).
Results: Thirty patients (mean age 58 years, range 29-79 years) had 40 spinal surgeries for metastatic RCC. Indications for surgery included disabling pain (70%) and neurological dysfunction (30%). Three total en-bloc spondylectomies (mean survival 54.6 months, p = 0.051) were performed and internal fixation was performed in all but one patient. Fifteen patients underwent preoperative spinal radiation therapy, twelve had preoperative chemo- or immuno- therapy, and twelve had preoperative embolization. Kaplan-Meier estimate revealed a median post-operative survival of 11.4 months. Visceral (p = 0.002) and osseus (p = 0.009) metastases were associated with decreased survival. Frankel grade was the same or improved in (78%) of patients. There were ten major post-operative complications and three perioperative mortalities.
Conclusions: In patients with metastatic RCC, resection and fixation can provide pain relief and neurological stabilization, but surgical morbidity remains high. Patients with solitary metastases may experience relatively long-term survival and may benefit from more aggressive surgical intervention.
Patient Care: Illuminate the characteristics of patients with RCC spine metastases and determine factors associated with improved survival.
Learning Objectives: By the conclusion of this session, participants should be able to 1) understand the presentation of patients with RCC spine metastases, 2) describe the factors affecting survival in patients with RCC spinal metastases and 3) understand risks associated with surgery for RCC spinal metastases.