Role of metastasectomy in the management of renal cell carcinoma

Abstract

Treatment of metastatic renal cell carcinoma (mRCC) has evolved with the development of a variety of systemic agents; however, these therapies alone rarely lead to a complete response. Complete consolidative surgery with surgical metastasectomy has been associated with improved survival outcomes in well-selected patients in previous reports. No randomized control trial exists to determine the effectiveness of metastasectomy. Therefore, reviewing observational studies is important to best determine which patients are most appropriate for metastasectomy for mRCC and if such treatment continues to be effective with the development of new systemic therapies such as immunotherapy. In this narrative review, we discuss the indications for metastasectomies, outcomes, factors associated with improved survival, and special considerations such as location of metastasis, number of metastases, synchronous metastases, and use of systemic therapy. Additionally, alternative treatment options and trials involving metastasectomy will be reviewed.

Therapeutic options for different metastatic sites arising from renal cell carcinoma: A review

“…[16,17] To optimize the survival of mRCC patients, precise patient selection predicated on baseline prognostic factors and various aspects of the patient's clinical status, including performance status, age, disease progression, site of metastasis, and therapeutic objectives, is indispensable. [18] The management paradigm for mRCC is undergoing rapid evolution. Options such as cytoreductive nephrectomy (CN) and surgical metastasectomy remain viable for a subset of patients.…”

“…[16,17] To optimize the survival of mRCC patients, precise patient selection predicated on baseline prognostic factors and various aspects of the patient’s clinical status, including performance status, age, disease progression, site of metastasis, and therapeutic objectives, is indispensable. [18]…”

Management of Metastatic Clear Cell Renal Cell Carcinoma: ASCO Guideline Q&A

“…Metastasis-directed therapy such as surgery, radiation, or thermal ablation may be considered for select patients on surveillance. 11 Close monitoring for disease progression with regular serial imaging, including bone and CNS imaging, is essential to this approach. The benefit of preserving quality of life (QoL) and delaying or avoiding treatment-related side effects versus the potential for disease progression should be discussed with the patient to incorporate their preferences in the decision-making process.…”

The Pancreas as a Target of Metastasis from Renal Cell Carcinoma: Is Surgery Feasible and Safe? A Single-Center Experience in a High-Volume and Certified Pancreatic Surgery Center in Germany

“…The surgical option, particularly in cases of single-site metastasis among surgically fit patients, is considered to be a valuable and only curative choice in the treatment of mCCRCC, irrespective of the site of the metastasis. Therefore, surgical resection of the metastasis is expected to enhance disease-free survival [7].…”

“…This combination has demonstrated superiority over sunitinib in terms of overall response rate and progression-free survival (PFS). Despite the advances in targeted therapy, achieving a complete response and cure for mCCRCC through systemic treatment alone remains rare [7][8][9][10].…”