Renal cell carcinoma clinically involving adjacent organs

Abstract

BACKGROUND.Historically, patients with nonmetastatic renal cell carcinoma (RCC) involving adjacent organs have been considered inoperable and incurable. The oncologic efficacy of an aggressive surgical approach was evaluated in a selected subpopulation of RCC patients. Further, an attempt was made to define the clinical and pathologic characteristics predictive of surgical failure.METHODS.With Institutional Review Board approval, the institutional nephrectomy database of 3470 patients treated at MD Anderson Cancer Center from 1990 to 2006 was searched for RCC patients treated with radical nephrectomy and resection of at least 1 adjacent organ thought to be directly involved by RCC. Patients with nonmetastatic RCC and a minimum follow‐up of 6 months were included in the analysis.RESULTS.In all, 30 patients with clinical T4NxM0 RCC and median follow‐up of 32.3 months (range, 8.5–140.1) met the study inclusion criteria and comprise the dataset for the analysis. On pathologic evaluation 60% of patients were clinically overstaged, as only 12 (40%) of 30 patients demonstrated direct invasion into adjacent organs resected. None of the clinical tumor characteristics predicted a finding of pathologic T4 RCC. Nodal involvement and pathologic T stage were significant independent predictors of disease recurrence (hazard ratio [HR] 3.726, P = .043, and HR 2.414, P = .045, respectively) and cancer‐specific survival (HR 17.145, P = .002, and HR 3.791, P = .024, respectively). Disease recurred in 11 of 18 (61.1%) of <pT4 patients and in 10 of 12 (83.3%) of pT4 patients at a median 13.3 and 2.3 months, respectively; 13 (73.3%) <pT4 patients and 5 (41.7%) pT4 patients were alive at the time of analysis.CONCLUSIONS.True pathologic involvement of adjacent organs by RCC cannot be predicted from pre‐ or intraoperative parameters. A significant proportion of patients clinically suspected of having T4 RCC are downstaged, and benefit from aggressive surgical resection with en bloc removal of involved organs. Cancer 2007. © 2007 American Cancer Society.

Resection of Pancreas and Duodenum During Radical Nephrectomy: Analysis of A Single Center Experience

“…In one series, colon, pancreas, and diaphragm were the most commonly resected organs in patients (n = 12) with T4 disease. Although 10 patients developed recurrence at a median time of 2.3 months, 5 (42%) patients were still alive at the time of analysis [7]. In another study of 26 patients at the Memorial Sloan Kettering Cancer Center (MSKCC), pancreas (23%) and bowel (23%) resections were among the more commonly resected organs, along with liver (39%), IVC (35%), vertebral body (31%), spleen (12%), and psoas muscle (7%); with 4 (15%) of those patients still alive at follow up [8].…”

“…Resection for locally advanced RCC has increasingly been performed with acceptable morbidity and mortality rates in the last few years [5,6], and there are some series describing such an aggressive approach with modest survival benefit in this group of patients [7,8]. Furthermore, clinical and pathological stage discrepancy is common in surgically treated patients which can have significant impact on clinical outcome [9].…”

Treatment of Renal Cell Carcinomas

“…40-60 % of patients may be cured by such aggressive surgical management [ 11 ]. When there is a solitary resectable metastasis, nephrectomy can be combined with metastasectomy.…”

Surgical management of renal cell carcinoma: Canadian Kidney Cancer Forum Consensus

“…124,[179][180][181] A significant proportion of these patients will have occult lymph node metastases, and regional lymphadenectomy should therefore be considered for adequate pathologic staging. 178,182,183 Pre-surgical systemic treatments are experimental and phase III trials evaluating adjuvant systemic agents are ongoing.…”

“…178 The goal of surgery is to remove all known disease, with possible concomitant resection of involved organs, such as the adrenal gland, liver, pancreas, diaphragm, and bowel. It is recommended that these cases are performed at high volume centres with a multidisciplinary surgical team.…”