Survival and Reoperation After Intralesional Procedures Versus Resection and Reconstruction for Renal Cell Carcinoma Bone Metastases

Background: The management of renal cell carcinoma (RCC) long-bone metastases often involves surgery with either resection and reconstruction (R&R) or intralesional (IL) procedures. Some literature suggests that R&R improves survival and reduces the risk of recurrence and reoperation, while IL procedures offer lower surgical morbidity and faster recovery. We compared survival and reoperation outcomes following IL versus R&R procedures for RCC long-bone metastases treated at our institution. Methods: We retrospectively reviewed patients with histologically confirmed RCC long-bone metastases treated surgically between July 1, 2005, and June 1, 2022. Medical charts were reviewed to collect data on demographics, treatment history, and outcomes. Multivariable Cox proportional-hazards regression and Fine-Gray competing-risks regression were used to evaluate survival and reoperation following IL and R&R procedures. Results: One hundred and five patients (68% male; mean age, 62.6 years; 96% White) with 133 metastases were included. IL surgery was not significantly associated with a greater cumulative incidence of reoperation (subdistribution hazard ratio [sHR] = 1.08, p = 0.87). Reoperations were primarily due to recurrent disease (29%) and pathologic fracture (33%) in the IL group, compared with recurrent disease (29%), pathologic fracture (14%), and wound infection (14%) in the R&R group. IL surgery was associated with a greater hazard of mortality in the overall cohort (HR = 2.03, p = 0.02), although no significant association was observed in the solitary metastasis subgroup (HR = 1.54, p = 0.49). Conclusions: IL procedures were associated with greater mortality, although this association was not observed among patients with a solitary metastasis. Given no significant difference in the cumulative incidence of reoperation between surgical approaches, IL and R&R procedures are both reasonable treatment options in appropriately selected patients and clinical settings. Level of Evidence: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.