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University hospital nijmegen, rotterdam, the netherlands. H. Vanderpoel@uro. Azn. Nl abstract objective: in 60-70% of patients with renal cell carcinoma (rcc), metastases develop in the course of the disease. In the present analysis, the surgical management of metastases is described, and survival data are presented. This retrospective analysis may help in the management of future cases. generic propecia Due to the retrospective nature of the data, no comparison between surgical and nonsurgical management is possible. Methods: between 1985 and 1995, 152 resections of rcc metastases were performed in cardinal patients at four dutch hospitals. Thirty-five and 6 patients had metastases resected 2 and 3 times, respectively. In most patients, the primary tumor was resected (n = 95). order propecia online Resections were performed for metastases at different locations: lung n = 54, bone n = 42, lymph nodes n = 18, cerebrum n = 12 and locations in the spinal canal, thyroid, bowel, and testis. propecia online without prescription Skin excisions were excluded from the analysis. Solitary metastases were resected in 40 patients. Results: median survival after the initial metastasectomy was 28 months. Initial tumor stage, grade, or size were not related to metastasis location or survival. The number of initially resected pulmonary metastases was of no influence on survival, however, multiple consecutive resections were related with longer survival. Patients with solitary metastases (n = 40) did not show longer survival after the first metastasectomy compared to no solitary lesions. Better survival was found for lung metastases compared to other tumor locations (p = 0. propecia no prescription 0006, log rank test) and for patients that were clinically tumor free after metastasectomy (p = 0. 0230, log rank test). Additional immuno- or radiotherapy did not independently influence survival. Time interval between primary tumor resection and metastasectomy correlated positively with survival: a tumor-free interval of more than 2 years between primary tumor and metastasis was accompanied by a longer disease-specific survival after metastasectomy. Eleven patients were free of disease after metastasectomy with a median time of 47 (14-65) months. The median time of hospital admittance for metastasectomy was 9 days (4-64). Lethal complications were found in 2 patients. Long-term (>5 years) disease-free survival was achieved in 7% of patients whereas 14% of patients were free of disease with a minimal follow-up of 45 months. propecia online without prescription Conclusions: (1) surgical management of metastases could be performed with short hospital stay, and low complication rates were found. (2) disease-free survival was found in 14 and 7%, with follow-ups of at least 45 and 60 months, respectively. (3) the longest survival was found after surgery for pulmonary lesions. (4) resection of solitary metastases did not result in longer survival compared to resection of nonsolitary lesions. propecia for sale (5) an interval shorter than 2 years between primary tumor and metastases was correlated with a shorter disease-specific survival. Buy lasix online Pmid: 10072620 [pubmed - indexed for medline] publication types, mesh terms publication types multicenter study mesh terms carcinoma, renal cell/mortality carcinoma, renal cell/secondary* carcinoma, renal cell/surgery* disease-free survival female follow-up studies humans kidney neoplasms/pathology male middle aged netherlands/epidemiology proportional hazards models retrospective studies time factors linkout - more resources full text sources s. Karger ag, basel, switzerland ebsco other literature sources cos scholar universe miscellaneous swets information services supplemental content save items add to favorites loading related citations in pubmed prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. order propecia [eur urol. 2005] prognostic factors and survival after pulmonary resection of metastatic renal cell carcinoma. Hofmann hs, neef h, krohe k, andreev p, silber re. Eur urol. 2005 jul; 48(1):77-81; discussion 81-2. Epub 2005 mar 20. Surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review. [ann surg oncol. propecia online without prescription 1994] surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review. propecia online without prescription Kierney pc, van heerden ja, segura jw, weaver al. Ann surg oncol. 1994 jul; 1(4):345-52. [pulmonary metastases of the clear cell (conventional) renal cell carcinoma--options and results of surgical treatment]. [klin onkol. 2011] [pulmonary metastases of the clear cell (conventional) renal cell carcinoma--options and results of surgical treatment]. propecia online without prescription Vodicka j, spidlen v, simã¡nek v, safrã¡nek j, fichtl j, mukensnabl p, fãnek j, rousarovã¡ m. Klin onkol. 2011; 24(4):293-7. Review renal cell carcinoma: resection of solitary and multiple metastases. [ann thorac surg. 1992] review renal cell carcinoma: resection of solitary and multiple metastases. Pogrebniak hw, haas g, linehan wm, rosenberg sa, pass hi. Ann thorac surg. 1992 jul; 54(1):33-8. Review renal cell carcinoma metastatic to the pancreas: a single-institution series and review of the literature. [urology. 2000] review renal cell carcinoma metastatic to the pancreas: a single-institution series an. Some people are advocates, speaking up for the people everyone else ignores. Some are organizers, gathering people and ideas from all corners of Mississippi. Some are program leaders, developing resources that local communities need to address their problems.