| Summary: | In this paper we aimed to address the role of pulmonary metastasectomy (PM) in patients affected by Lung Metastases (LM) from Renal Cell Carcinoma (RCC) and to analyse prognostic factors affecting overall survival (OS), disease-free interval (DFI) between primary RCC and first LM, and disease-free survival (DFS) after PM and before lung recurrence. Medical records of 210 patients who underwent PM from RCC in 4 Italian Thoracic Centres, from January 2000 to September 2019, were collected and analysed. All patients underwent RCC resection before lung surgery. The main RCC histology was clear cells (188, 89.5%). The 5- and 10-year OS from the first lung operation were 60% and 34%, respectively. LM synchronous with RCC (<i>p</i> = 0.01) and (Karnofsky Performance Status Scale) KPSS < 80% (<i>p</i> < 0.001) negatively influenced OS. Five- and 10-year DFI were 54% and 28%, respectively. The main factors negatively influencing DFI were: male gender (<i>p</i> = 0.039), KPSS < 80% (<i>p</i> = 0.009) and lactate dehydrogenase > 1.5 times 140 U/L (<i>p</i> = 0.001). Five- and 10-year disease-free survival were 54% and 28%, respectively; multiple LM (<i>p</i> = 0.036), KPSS < 80% (<i>p</i> = 0.001) and histology of RCC other than clear cells negatively influenced disease-free survival. Conclusions: patients with KPSS > 80%, single metachronous LM with a long DFI from RCC diagnosis, and clear cell histology, benefit from pulmonary metastasectomy.
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