designed by Ociated with survival in surgery patients. viagra cost Those undergoing synchronous resections lived a median of 1. generic viagra online 1 years following liver resection compared to 5. 7 years in those resected in the metachronous setting (p = 0. 02; figure 2). cheap viagra online  figure 1  overall survival of the 18 patients who underwent liver resection (n = 10) or radiofrequency ablation (n = 8) for metastatic renal cell carcinoma. The 5-year actuarial survival was 27% for all patients. (click on the image to enlarge. )  figure 2  overall survival of the 10 patients who underwent synchronous versus metachronous liver resection for metastatic renal cell carcinoma. Median survival for the synchronous group was 1. 1 years versus 5. order viagra online 7 years in the metachronous group. viagra 10mg (click on the image to enlarge. buy generic viagra ) we did not see statistical significance with respect to survival according to the number of liver metastases, disease free interval (dfi), presence of extra hepatic disease, resection of extra hepatic disease or rendering a patient completely ned. Discussion top introduction materials and methods results discussion conclusions acknowledgements references approximately, 80% of patients with renal cell carcinoma will develop metastases; of these, 20-40% will develop liver disease. Historically, liver metastases have been an ominous prognostic feature. In fact, those with hepatic disease have been found to live a median of 7. yahoo mail problems viagra 4 months [4]. One may therefore state that tumor burden in the liver is often a rate limiting step for survival. The poor outcome of patients with liver metastases may partly be explained by the fact that, in most cases, liver metastases are multiple and occur in association with metastases to other sites which is in accordance with the hematogenous pattern of spread of rcc [5]. In fact, liver metastases of rcc are solitary in only 2 to 4% of cases [5]. viagra for sale The question, which therefore remains, is whether liver directed therapy with or without extra hepatic disease is associated with increased survival? Response to systemic therapy remains poor. Objective response rates are only seen in 15% of patients with high dose il-2 and chemotherapy responses remain inferior. In the modern day of hepatobiliary surgery mortality rates are low (0 - 2%) and morbidity rates are reasonable (33%) [3]. Thirty percent mortality associated with liver resection is no longer the case [6]. viagra women recreational use That being said, liver resection for metastatic rcc rema.