Surgical Approaches for RCC Bone Metastases Show No Significant Reoperation Difference

A retrospective study in The Journal of Bone and Joint Surgery compared survival and reoperation after intralesional procedures versus resection and reconstruction for renal cell carcinoma (RCC) long-bone metastases. Investigators reviewed 105 patients with 133 metastases treated at one institution between July 2005 and June 2022. Initial surgery was intralesional in 74 patients and resection and reconstruction in 31. Analyses used adjusted survival models and competing-risk models accounting for death before reoperation.

Intralesional surgery was not significantly associated with reoperation incidence relative to resection and reconstruction (subdistribution hazard ratio, 1.08; p=0.87). It was associated with higher mortality in the overall cohort (hazard ratio, 2.03; p=0.02), but no significant association was observed among patients with a solitary metastasis (hazard ratio, 1.54; p=0.49). Recurrent disease accounted for 29% of reoperations in each group; pathologic fracture accounted for 33% after intralesional procedures and 14% after resection and reconstruction.

The authors consider both approaches reasonable in appropriately selected patients. However, surgery selection incorporated overall health, functional status, and anticipated mortality, leaving potential confounding despite adjustment. The single-center, retrospective design cannot establish a survival benefit from resection. Limited statistical power also means that nonsignificant reoperation and subgroup findings should not be interpreted as equivalence.