The Role of Surgery in Spinal Intradural Metastases from Renal Cell Carcinoma: A Literature Review

SIMPLE SUMMARY: Renal cell carcinoma is a highly metastatic tumor, mainly to the lungs (50%), bone (49%), lymph-nodes (6–32%), liver (8%), and brain (3%). A wide and accurate literature review has disclosed only 51 cases of intradural spinal metastasis from sporadic renal cell carcinoma, of which 32 at intramedullary and 19 at extramedullary localizations. Once detected, they represent a sign of advanced disease and often lead to rapidly progressive neurological deficits. Because of these few reported data, there are no defined guidelines of treatment and the decision making in the choice of the best strategy should consider the curative, functional and palliative aspects, accordingly the management should be tailored for each patient. The options include surgery, radiotherapy, and chemotherapy, which can be performed in isolation or various combinations at the discretion of each institution. We discuss the role of surgery in the management of spinal intradural metastases from renal cell carcinoma. ABSTRACT: Background: Due to the few reported cases of spinal intradural metastases from renal cell carcinoma (RCC), there is no unanimous consensus on the best treatment strategy, including the role of surgery. Methods: A wide and accurate literature review up to January 2022 has disclosed only 51 cases of spinal intradural metastases from RCC. Patients with extramedullary (19) and those with intramedullary (32) localization have been separately considered and compared. Demographics, clinical, pathological, management, and outcome features have been analyzed. Results: Extramedullary lesions more frequently showed the involvement of the lumbar spine, low back pain, and solitary metastasis at diagnosis. Conversely, the intramedullary lesions were most often detected in association with multiple localizations of disease, mainly in the brain. Surgery resulted in improvement of clinical symptoms in both groups. Conclusion: Several factors affect the prognosis of metastatic RCC. The surgical removal of spinal metastases resulted in pain relief and the arresting of neurological deficit progression, improving the quality of life and overall survival of the patient. Considering the relative radioresistant nature of the RCC, the surgical treatment of the metastasis is a valid option even if it is subtotal, with a consequent increased risk of recurrence, and/or a nerve root should be sacrificed.