Metastasectomy in Advanced Renal Cell Carcinoma: A Systematic Review

Abstract

Introduction: Metastasectomy for advanced renal cell carcinoma has been practiced for over 80 years. However, there is uncertainty regarding the clinical benefit of this procedure and the optimum selection of appropriate patients. Materials and Methods: A systematic literature search was conducted according to the PRISMA statement to identify studies that reported outcomes in patients who underwent metastasectomy at any time. Primary endpoints were overall and disease-free survival. Radiation therapy studies were not included. Case reports and series with less than 20 patients were not included. Results: Forty-four studies were identified that met the criteria for inclusion, with a total of 4195 patients. No studies that randomized patients to surgery versus no surgery were identified. Disease-free interval, number of metastatic sites and completeness of resection were prognostic for overall survival in many of the included studies. Seventeen studies included patients with lung metastases only (1465 patients in total). Conclusions: Case series have documented patients with prolonged disease-free interval and survival after metastasectomy. However, without randomized data, the impact of metastasectomy on outcomes in patients with metastatic renal cell carcinoma (mRCC) remains unknown, especially in the evolving landscape of systemic therapies.

Renal Cell Carcinoma with or without Tumor Thrombus Invading the Liver, Pancreas and Duodenum

“…Actually, two recent systematic reviews suggested that complete metastasectomy is associated with better survival (range, 36.5–142 months vs. 8.4–27 months) and/or symptomatic control when compared to no or incomplete metastasectomy [ 28 ]. Comparable outcomes have been reported in the context of the resection of multiple metastatic sites, local/distant lymph nodes, and local recurrences [ 29 ]. In fact, disease-free intervals after complete resection may be notable, thus avoiding systemic treatment requirements at least in the first instance [ 30 ].…”

Zalecenia Postępowania Diagnostyczno-Terapeutycznego W Raku Nerkowokomórkowym

“…Patients with metastases limited to the lungs had the best prognosis [110]. Radical MX of lung metastases compared to non-radical management is associated with a significant prognosis improvement with median OS of 69 months (radical MX) versus 19 months (non-radical MX; P < 0.00001) and a 5-year CSS of 73,6% versus 19%, respectively [111]. Slightly worse results of surgical MX were obtained in cases of metastases of unusual or rare location (skin, muscles, salivary glands, breast, nasopharynx, stomach).…”

Randomized, Double-Blind Phase III Study of Pazopanib Versus Placebo in Patients With Metastatic Renal Cell Carcinoma Who Have No Evidence of Disease After Metastasectomy: ECOG-ACRIN E2810

“…8 Nevertheless, the risk of recurrence after metastasectomy is high, with DFS generally much shorter than in even high-risk postnephrectomy series. 9 The high risk of recurrence after metastasectomy demonstrates an unmet need for effective systemic therapy in the no evidence of disease (NED) setting. Tyrosine kinase inhibitors (TKI) targeting vascular endothelial growth factor receptor (VEGFR) and other targets are active against metastatic clear cell RCC, 1 but at the time this study was opened, no data were available in the postmetastasectomy or postnephrectomy (adjuvant) setting.…”