Management of distant solitary recurrence in the patient with renal cancer: Contralateral kidney and other sites

About 25% to 57% of patients with RCC exhibit overt evidence of metastatic disease at the time of initial presentation. These patients have an average survival of about 4 months, and only 10% of them survive 1 year. Metachronous metastatic disease may develop in approximately 50% of patients who have undergone a presumably curative radical nephrectomy. Seventy percent of these patients relapse within the first year and manifest a median survival of about 11 months. The incidence of solitary metastatic lesions in patients with RCC ranges from 1.6% to 3.6%. In reality, the vast majority of these patients have evidence of subclinical, multifocal, micrometastatic disease and ultimately succumb to metastatic RCC. However, a 5-year survival rate of 35% to 50% can be achieved in properly selected patients using aggressive surgical treatment as a major component of therapy. In large part, insightful patient selection is predicated upon an understanding of the unique biologic and clinical issues relevant to each organ site of involvement.