Cytoreductive Nephrectomy and Nephrectomy/Complete Metastasectomy for Metastatic Renal Cancer

Russo, Paul; Synder, Mark; Kondagunta, Varuni; Motzer, Robert J.

doi:10.1100/tswurol.2007.60

Cited by 12 publications

(8 citation statements)

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“…18 The other study reported longer survival associated with CM without statistical comparison (30 vs 12 months). 19 A forest plot summary of the hazard ratios (HRs) between CM and CSS and OS across organ sites unequivocally favored CM.…”

Section: Complete Versus Incomplete Metastasectomy/ Absence Of Metastmentioning

confidence: 99%

“…37,38 In terms of determining the optimal timing of metastasectomy with respect to cytoreductive nephrectomy in patients with synchronous metastases, high-volume centers have described the safety and feasibility of concurrent metastasectomy in carefully selected patients. 34,39 However, to our knowledge, there are limited data regarding the comparative efficacy of metastasectomy at the time of cytoreductive nephrectomy versus delayed treatment of metastases. Recommendations regarding combined versus separate procedures must be approached on a case-by-case basis, taking into account the complexity of a combined surgical procedure, the location of the metastases with respect to the kidney (eg, osseous or pulmonary metastases may require separate incisions and different surgical equipment), the availability of other modalities to treat the metastatic deposits (eg, thermal ablation and radiotherapy; see sections below), and the fitness of the patient to undergo a potentially longer, more complex procedure.…”

Section: Surgical Considerations and Complications Related To Metastamentioning

confidence: 99%

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Role of metastasis‐directed treatment in kidney cancer

Psutka

Master

2018

Cancer

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Despite the rapid elaboration of multiple, novel systemic agents introduced for metastatic renal cell carcinoma (mRCC) in recent years, a durable complete response remains elusive with systemic therapy alone. Definitive treatment of the metastatic deposit remains the sole potentially curative option and is a cornerstone of mRCC therapy, offering potential for both local control and palliation of tumor-related symptoms. In this review, the evidence supporting the definitive treatment of mRCC is examined and summarized, including the use of surgical metastasectomy, thermal ablation, radiotherapy, and other minimally invasive options. Multimodal approaches, including the combination of metastasectomy with novel systemic agents, are discussed. Finally, the authors review considerations for patient selection for this type of therapy and summarize available risk-stratification tools that may help guide shared decision making.

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Section: Complete Versus Incomplete Metastasectomy/ Absence Of Metastmentioning

confidence: 99%

Section: Surgical Considerations and Complications Related To Metastamentioning

confidence: 99%

Role of metastasis‐directed treatment in kidney cancer

Psutka

Master

2018

Cancer

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“…11 Although there is some evidence that metastasectomy at the time of nephrectomy is beneficial, whether this applies to lymphadenopathy has not been established. 12 The aim of the present study was to further evaluate the utility of carrying out LND during cytoreductive nephrectomy. Our primary objective was to determine whether LND imparted a survival benefit in patients undergoing cytoreductive nephrectomy, with further analyses to determine whether LND template or number of nodes removed are important variables.…”

Section: Introductionmentioning

confidence: 99%

Lymph node dissection during cytoreductive nephrectomy: A retrospective analysis

et al. 2014

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Objective To assess whether regional lymph node dissection (LND) could improve the prognosis of patients with metastatic renal cell carcinoma (RCC). Methods We reviewed data on 258 patients who underwent cytoreductive nephrectomy at our institution, some of whom received a concurrent LND. Primary outcome measure was overall survival. A Cox proportional hazards regression model included, age, pathologic stage, lymphadenopathy, tumor size, modified MSKCC criteria, site of metastatic disease, and LND. We created a logistic regression model to evaluate risk factors for node-positive disease. Survival analyses were performed for lymph node template (hilar vs other) and number of nodes removed (0–3, 4–7, or ≥8). Results Of 258 patients, 177 (69%) underwent LND, and positive nodes were found in 59 (33%). Five-year overall survival was 21% for patients who underwent LND and 31% for patients who did not. We found no significant difference in survival among patients receiving or not receiving LND. Five-year overall survival was 27% and 9% for negative and positive nodal status, respectively (p <0.0005). For patients who underwent LND, the presence of lymphadenopathy was a significant predictor of node-positive disease (odds ratio 25.0, 95% CI 9.04–69.4, p <0.0001). Conclusions LND performed during cytoreductive nephrectomy was not associated with a survival benefit. Lymph node–positive disease was identified as a poor prognostic variable; therefore, LND should be considered as a staging procedure for clinical trials.

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“…Most of these deaths occur in patients who present with large, locally advanced tumours that have already or will soon metastasize. The overall survival for patients with locally advanced large renal cortical tumours (RCTs) or metastatic disease is generally poor, with 5-year survival rates of < 10% [2]. Partial (PN) or radical nephrectomy (RN) remain the established treatment for small (T1) renal lesions, while patients with large, locally advanced (T3 or T4) lesions are often designated as 'unresectable' and not offered surgery.…”

Section: Introductionmentioning

confidence: 99%

Advanced‐stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection

Karellas¹,

Jang²,

Kagiwada³

et al. 2008

BJU International

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OBJECTIVE To examine the effect of radical nephrectomy (RN) with adjacent organ and structure resection on survival, as invasion of adjacent organs in patients with renal cell carcinoma (RCC) is rare. PATIENTS AND METHODS After institutional review board approval, we reviewed our database and statistically analysed of patients with pathological stage T3 or T4 RCC who had RN and resection of a contiguous organ or structure. RESULTS We identified 38 patients of 2464 (1.5%) who had RN with adjacent organ or structure resection. The median (interquartile range) size of the mass was 11 (8–14) cm, and the follow‐up 13 (5–33) months. Most patients (68%) were pT4 stage and had conventional clear cell carcinoma (95%). Fourteen patients (37%) had positive surgical margins. The liver (10) was the most commonly resected adjacent organ or structure. Only one patient remains alive with no evidence of disease at 5 years, while three are currently alive with disease. Overall, 34 of 38 patients (90%) ultimately died from disease at a median (range) of 11.7 (5.4–29.2) months after surgical resection. The surgical margin status was the only statistically significant factor for recurrence and death (P = 0.006). CONCLUSIONS The prognosis for patients with advanced RCC and adjacent organ or structure involvement is extremely poor and similar to that of patients with metastatic disease. These patients should be thoroughly counselled about the impact of surgical management and considered for entry into neoadjuvant or adjuvant clinical trials with new targeted systemic agents.

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Cytoreductive Nephrectomy and Nephrectomy/Complete Metastasectomy for Metastatic Renal Cancer

Cited by 12 publications

References 0 publications

Role of metastasis‐directed treatment in kidney cancer

Role of metastasis‐directed treatment in kidney cancer

Lymph node dissection during cytoreductive nephrectomy: A retrospective analysis

Advanced‐stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection

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