Cytoreductive Nephrectomy in Metastatic Kidney Cancer: Experience of the Urology Department at Aristide Le Dantec University Teaching Hospital

Abstract

In the management of metastatic kidney cancer, enlarged nephrectomy is part of a multimodal approach with systemic treatment. The lack of data on its place in the management of metastatic kidney cancer in Africa and particularly in Senegal motivated this study. Aim: to assess the place of cytoreductive nephrectomy in the management of metastatic kidney cancer in our daily practice. Patients and methods: This was a retrospective, descriptive and analytical study from January 2010 to December 2014 on patients aged 18 years and over operated for metastatic kidney cancer. The variables studied were prognostic: Performance Status, tumor stage, sites and number of metastatic sites, prognosis group according to Heng's model, histological type and Furhman grade of the nephrectomy specimen, follow-up postoperative course and overall survival. Results: A total of 12 patients were included. The mean size of the largest axis of the tumors was 14.06±5.3 cm with extremes of 8.2 and 23.8 cm and the tumor was graded T3 in 6 cases. The majority of patients had a single metastatic site and the lung was the most common metastatic site in 9 cases. In half of the cases the ECOG-PS score was 1. In 6 cases the patients were classified in the Heng intermediate prognosis group. Lymph node dissection was associated with nephrectomy in 4 cases. Renal adenocarcinoma was the most common histologic type in 8 cases and Furhman's grade was only specified in 6 cases. The mean duration of follow-up was 10.1±13.4 months (range 1 and 39 months), overall survival at 2 years was poor and only 2 patients were alive 3 years and 4 years after their nephrectomy. Conclusion: metastatic kidney cancer is uncommon in our context, most of our patients consult with advanced stage tumors. Systemic treatment remains difficult for our populations to access. Nephrectomy remains the main weapon at our disposal.