{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:50:46Z","timestamp":1791399046455,"version":"4.3.3"},"reference-count":14,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The management of renal cell carcinoma (RCC) long-bone metastases often involves surgery with either resection and reconstruction (R&amp;R) or intralesional (IL) procedures. Some literature suggests that R&amp;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&amp;R procedures for RCC long-bone metastases treated at our institution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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&amp;R procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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&amp;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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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&amp;R procedures are both reasonable treatment options in appropriately selected patients and clinical settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.01377","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:01:26Z","timestamp":1791396086000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Survival and Reoperation After Intralesional Procedures Versus Resection and Reconstruction for Renal Cell Carcinoma Bone Metastases"],"prefix":"10.2106","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8753-8685","authenticated-orcid":false,"given":"Jayanth","family":"Kashyap","sequence":"first","affiliation":[{"name":"University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3672-3548","authenticated-orcid":false,"given":"Luke A.","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Colorado Anschutz, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4472-3793","authenticated-orcid":false,"given":"Lawrence E.","family":"Garvin","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5398-8962","authenticated-orcid":false,"given":"Karen E.","family":"Schoedel","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9979-9400","authenticated-orcid":false,"given":"Ines","family":"Lohse","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2370-5678","authenticated-orcid":false,"given":"Stella J.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard L.","family":"McGough","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3859-728X","authenticated-orcid":false,"given":"Kurt R.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"issue":"3","key":"bib1-20261007","doi-asserted-by":"crossref","first-page":"79","DOI":"10.14740\/wjon1279","article-title":"Epidemiology of Renal Cell Carcinoma","volume":"11","author":"Padala","year":"2020","journal-title":"World J Oncol."},{"issue":"8","key":"bib2-20261007","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1038\/s41585-018-0034-9","article-title":"An interdisciplinary consensus on the management of bone metastases from renal cell carcinoma","volume":"15","author":"Gr\u00fcnwald","year":"2018","journal-title":"Nat Rev Urol."},{"issue":"8","key":"bib3-20261007","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.2106\/00004623-200708000-00018","article-title":"Patient survival after surgery for osseous metastases from renal cell carcinoma","volume":"89","author":"Lin","year":"2007","journal-title":"J Bone Joint Surg Am."},{"key":"bib4-20261007","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/1471-2474-11-145","article-title":"Bone metastases from renal cell carcinoma: patient survival after surgical treatment","volume":"11","author":"Fottner","year":"2010","journal-title":"BMC Musculoskelet Disord."},{"issue":"1","key":"bib5-20261007","first-page":"577","article-title":"The Efficacy of Wide Resection for Musculoskeletal Metastatic Lesions of Renal Cell Carcinoma","volume":"38","author":"Higuchi","year":"2018","journal-title":"Anticancer Res."},{"issue":"7","key":"bib6-20261007","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1002\/jso.23134","article-title":"Treatment and survival of osseous renal cell carcinoma metastases","volume":"106","author":"Evenski","year":"2012","journal-title":"J Surg Oncol."},{"issue":"2","key":"bib7-20261007","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1002\/jso.24284","article-title":"Metastasectomy, intralesional resection, or stabilization only in the treatment of bone metastases from renal cell carcinoma","volume":"114","author":"Langerhuizen","year":"2016","journal-title":"J Surg Oncol."},{"key":"bib8-20261007","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/01.blo.0000059580.08469.3e","article-title":"Treatment of osseous metastases in patients with renal cell carcinoma","volume":"409","author":"Jung","year":"2003","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib9-20261007","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1302\/0301-620X.82B1.0820062","article-title":"Radical surgery for the solitary bony metastasis from renal-cell carcinoma","volume":"82","author":"Baloch","year":"2000","journal-title":"J Bone Joint Surg Br."},{"key":"bib10-20261007","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/01.blo.0000149820.65137.b4","article-title":"Solitary bony metastasis from renal cell carcinoma: significance of surgical treatment","volume":"431","author":"Fuchs","year":"2005","journal-title":"Clin Orthop Relat Res."},{"key":"bib11-20261007","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/00003086-200109000-00023","article-title":"Local progression after operative treatment of metastatic kidney cancer","volume":"390","author":"Les","year":"2001","journal-title":"Clin Orthop Relat Res."},{"issue":"9","key":"bib12-20261007","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1302\/0301-620X.100B9.BJJ-2017-1163.R3","article-title":"Long-term patient survival after the surgical treatment of bone and soft-tissue metastases from renal cell carcinoma","volume":"100-B","author":"Higuchi","year":"2018","journal-title":"Bone Joint J."},{"issue":"7","key":"bib13-20261007","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s10585-016-9805-y","article-title":"Prognostic significance of intensive local therapy to bone lesions in renal cell carcinoma patients with bone metastasis","volume":"33","author":"Fukushima","year":"2016","journal-title":"Clin Exp Metastasis."},{"key":"bib14-20261007","doi-asserted-by":"crossref","first-page":"102639","DOI":"10.1016\/j.canep.2024.102639","article-title":"Changes in the overall survival of patients with metastatic renal cell carcinoma in the era of immune-checkpoint inhibitors","volume":"92","author":"Adhikari","year":"2024","journal-title":"Cancer Epidemiol."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01377","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:01:28Z","timestamp":1791396088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01377"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":14,"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01377","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,7]]}}}