[Surgical treatment of pulmonary metastases in metastatic renal cell carcinoma].

Between 20 and 30 % of patients diagnosed with renal cell carcinoma suffer from metastatic disease by the time of diagnosis and a further 20 - 30 % develop metachronous metastases after initial treatment with curative intent. The therapeutic landscape of metastatic renal cell carcinoma seems be changing rapidly, with new systemic therapies or combination therapies available and established concepts being questioned because of long-awaited data. Apart from systemic therapy, metastases can be treated by surgical resection. As the most common site of metastases in renal cell carcinoma, the lung plays an important role in local treatment. Pulmonal metastasectomy is a safe procedure with low morbidity and mortality in the "right" patients. Nevertheless, there are only data from retrospective non-randomised comparative studies, which seem to show that complete metastasectomy is associated with a better prognosis and overall survival of patients. Patients with a solitary pulmonal metastasis, without involvement of hilar or mediastinal lymph nodes and a long disease-free interval after primary therapy, might benefit the most from surgery. Repeated metastasectomy can also be performed, although the data are sparse - which emphasises the need for interdisciplinary case discussions and individual therapy, as recommended in primary metastasectomy.