Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2020; 8(19): 4450-4465
Published online Oct 6, 2020. doi: 10.12998/wjcc.v8.i19.4450
Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature
Emilio De Raffele, Mariateresa Mirarchi, Riccardo Casadei, Claudio Ricci, Eugenio Brunocilla, Francesco Minni
Emilio De Raffele, Dipartimento dell'Apparato Digerente, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
Mariateresa Mirarchi, Dipartimento Strutturale Chirurgico, Ospedale SS Antonio e Margherita, Tortona (AL) 15057, Italy
Riccardo Casadei, Claudio Ricci, Francesco Minni, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
Eugenio Brunocilla, Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale (DIMES), Alma Mater Studiorum, Policlinico S.Orsola-Malpighi, University of Bologna, Bologna 40138, Italy
Author contributions: De Raffele E contributed to conception and design of the study, acquisition, analysis and interpretation of data, and wrote the manuscript; Mirarchi M contributed to conception and design of the study, acquisition, analysis and interpretation of data; Casadei R and Ricci C contributed to analysis and interpretation of data; Brunocilla E contributed to analysis and interpretation of data and critically revised the manuscript; Minni F critically revised the manuscript; and all authors have read and agreed to the present version of this manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: None of the authors have any conflict of interest related to this publication.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016); the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Emilio De Raffele, MD, PhD, Surgeon, Surgical Oncologist, Dipartimento dell'Apparato Digerente, Policlinico S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, Bologna 40138, Italy. e.deraffele@aosp.bo.it
Received: June 26, 2020
Peer-review started: June 26, 2020
First decision: July 24, 2020
Revised: July 31, 2020
Accepted: September 2, 2020
Article in press: September 2, 2020
Published online: October 6, 2020
Processing time: 93 Days and 8.7 Hours
Abstract
BACKGROUND

The therapeutic approach of metastatic renal cell carcinoma (RCC) represents a real challenge for clinicians, because of the variable clinical course; the recent availability of numerous targeted therapies that have significantly improved overall oncological results, but still with a low percentage of complete responses; and the increasing role of metastasectomy (MSX) as an effective strategy to achieve a durable cure, or at least defer initiation of systemic therapies, in selected patients and in the context of multimodality treatment strategies.

CASE SUMMARY

We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC; he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy, with subsequent systemic therapy with Fluorouracil, Interferon-alpha and Interleukin 2. The subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences, successfully treated with multiple systemic treatments, repeated local treatments, including two pancreatic resections, conservative resection and ablation of multiple bilobar liver metastases, resection and stereotactic body radiotherapy of multiple lung metastases. He is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites, including resection of more than 38 metastases, and 5 years after his last MSX.

CONCLUSION

This case highlights that effective multimodality therapeutic strategies, including multiple systemic treatments and iterative aggressive surgical resection, can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.

Keywords: Renal cell carcinoma; Metastases; Surgery; Thermal ablation; Radiation; Case report; Systemic therapy

Core Tip: Therapeutic strategies of metastatic renal cell carcinoma include numerous effective targeted therapies and metastasectomy, which selectively permits to achieve durable cure or at least to defer initiation of systemic therapies, in the context of multimodality treatment strategies. We present herein the case of a patient with metastatic renal cell carcinoma, who was successfully treated with multiple systemic treatments, repeated surgical resection and multiple local treatments of more than 38 metachronous sequential metastases in the lung, pancreas, liver and mediastinal lymph nodes. He is alive without recurrence 20 years after nephrectomy and 5 years after his last metastasectomy.