Reply to: ‘Management of cardiac metastasis from renal carcinoma 11 yeaers after radical nephrectomy' by D Charbit et al.

We would like to thank Drs. Charbit, Nouhaud and Pfister for their comments ¹ on our recent article, ² and congratulate them for their efforts in a difficult case of cardiac metastasis from renal cell carcinoma. Late metastasis of renal cell carcinoma 10 years after nephrectomy for the primary disease is not so uncommon. However, isolated late cardiac metastasis of renal cell carcinoma that had no renal vein or lymph node invasion is a rare entity.

As mentioned in our paper, the accepted treatment for a malignant cardiac tumor is wide local excision with free margins on histological sections. However, it is sometimes difficult to perform complete resection for cardiac metastasis due to an insufficient free margin. Our concern is how to decide on the resection area during surgery. If neoadjuvant treatment is available, the surgical indication should be changed. Although the indication for cardiac surgery is still controversial, it should depend totally on the individual situation.

The clinical signs and symptoms of cardiac metastasis are unclear in the early stage. If we could detect cardiac metastasis in the early period, complete surgical resection for isolated cardiac metastasis could be performed more safely. To detect late cardiac metastasis earlier is challenging because follow-up might not be so perfect 10 years after primary surgery.