Abstract
We presented 3 cases of renal cell carcinoma with hepatic lesion, for which it was difficult to make a diagnosis preoperatively.
The hepatic lesion was cavernous hemangioma of the liver, liver metastasis of renal cell carcinoma or hepatocellular carcinoma.
To discuss the strategy of treatment for liver metastasis of renal cell carcinoma at the time of nephrectomy, or in the follow-up period after nephrectomy, we reviewed the 188 cases of renal cell carcinoma which were nephrectomized from December, 1962 to June, 1988. At the time of nephrectomy, there was only 1 case that had concurrent liver metastasis. In 4 cases, liver metastasis was found at autopsy, and in 15 cases, in the follow-up period after nephrectomy.
We analysed these 15 cases and classified them into 2 groups. One was “early metastasis group”, i. e., liver metastasis was found within 18 months after nephrectomy, and the other was “late metastasis group”, i. e., liver metastasis detected more than 6 years after nephrectomy.
In the “early metastasis group”, 2 lived 10 months or 57 months, but 5 died within 1 month after the appearance of liver metastasis. In the “late metastasis group”, 4 of 7 lived more than 2 years after the appearance of liver metastasis and the median survival was 21 months. In both groups, when liver metastasis was found, there were metastases in multiple organs and the hepatic lesions were multiple.
Since patients with renal cell carcinoma rarely have liver metastasis at the time of diagnosis, in cases with hepatic lesions not confirmed to be benign, it should be resected simultaneoulsy. The appearance of liver metastasis in the follow-up period after nephrectomy means the end stage in the natural course of renal cell carcinoma. But in some cases of the “late metastasis group”, with slow progression, surgical intervention for liver metastasis may be indicated.
