Role of the Laparoscopic Approach to Cytoreductive Nephrectomy in Metastatic Renal-Cell Carcinoma: Does Size Matter?

Ganeshappa, Anjana; Sundaram, Chandru P.; Lerner, Michelle A.; Gardner, Thomas A.

doi:10.1089/end.2009.0401

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…Laparoscopic CN has been shown to be safe and feasible (58,59). It has been associated with reduced morbidity and improved perioperative outcomes in several comparative series of laparoscopic vs. open CN, specifically estimated blood loss, transfusion rate, number of transfusions, time to oral intake and hospital stay (60)(61)(62)(63)(64). Importantly, these studies also show that laparoscopic CN does not appear to delay and may in fact shorten the interval from nephrectomy to commencement of systemic therapy.…”

Section: Minimally Invasive Cytoreductive Radical Nephrectomymentioning

confidence: 79%

Minimally invasive radical nephrectomy: a contemporary review

Ashrafi

Gill

2020

Transl Androl Urol

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Minimally invasive renal surgery has revolutionized the surgical management of renal cancer since the initial report of laparoscopic nephrectomy in 1991. Laparoscopic nephrectomy became the mainstay of management in surgically resectable renal masses since the 1990s. The growing body of literature supporting nephron-sparing surgery over the last two decades has meant that minimally invasive radical nephrectomy (MI-RN) is now the preferred treatment for renal tumors not amenable to partial nephrectomy. While there is a well-described experience with complex radical nephrectomy using standard laparoscopy, robot-assisted surgery has shortened the learning curve and facilitated greater uptake of minimally invasive surgery in difficult surgical scenarios traditionally performed open surgically. Increased experience and expertise with robot-assisted renal surgery has led to expansion of the indications for MI-RN to include larger masses, locally advanced renal masses invading adjacent tissues or regional hilar/ retroperitoneal lymph nodes, cytoreductive nephrectomy (CN) in metastatic disease, and concurrent venous tumor thrombectomy for renal vein or inferior vena cava (IVC) involvement. In this article, we review the various surgical techniques and adjunctive procedures associated with MI-RN.

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Section: Minimally Invasive Cytoreductive Radical Nephrectomymentioning

confidence: 79%

Minimally invasive radical nephrectomy: a contemporary review

Ashrafi

Gill

2020

Transl Androl Urol

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“…However, some studies have compared the laparoscopic route to open surgery. These studies have shown comparable results in terms of operating time, frequency of complications and time to start systemic treatment [25][26][27][28][29].…”

Section: Nephrectomymentioning

confidence: 85%

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

Amougou¹,

Sow²,

Dongmo³

et al. 2021

IJCU

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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.

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“…In the work of Zlatev et al, which evaluated 24,145 CNs performed in the United States of America in the years 2003-2015, it showed a trend in reducing the rate of open CN (OCN) from 76.7% to 66.4%, LCN from 22.3% to 11.4% and, conversely, an increase in robotically assisted CN (RaCN) from 0.6% to 22.1% [88]. LCN, compared to OCN, has demonstrated better perioperative outcomes (lower blood loss and shorter recovery time) and non-inferior oncological outcomes in several smaller studies [89][90][91][92]. LCN was also not associated with greater morbidity in delayed CN [93].…”

Section: Surgical Aspects Of Cytoreductive Nephrectomymentioning

confidence: 99%

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

Studentova,

Spisarova,

Kopova

et al. 2023

Cancers

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The role of cytoreductive nephrectomy in metastatic renal cell carcinoma (RCC) has been studied intensively over the past few decades. Interestingly, the opinion with regard to the importance of this procedure has switched from a recommendation as a standard of care to an almost complete refutation. However, no definitive agreement on cytoreductive nephrectomy, including the pros and cons of the procedure, has been reached, and the topic remains highly controversial. With the advent of immune checkpoint inhibitors, we have experienced a paradigm shift, with immunotherapy playing a crucial role in the treatment algorithm. Nevertheless, obtaining results from prospective clinical trials on the role of cytoreductive nephrectomy requires time, and once some data have been gathered, the standards of systemic therapy may be different, and we stand again at the beginning. This review summarizes current knowledge on the topic in the light of newly evolving treatment strategies. The crucial point is to recognize who could be an appropriate candidate for immediate cytoreductive surgery that may facilitate the effect of systemic therapy through tumor debulking, or who might benefit from deferred cytoreduction in the setting of an objective response of the tumor. The role of prognostic factors in management decisions as well as the technical details associated with performing the procedure from a urological perspective are discussed. Ongoing clinical trials that may bring new evidence for transforming therapeutic paradigms are listed.

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Role of the Laparoscopic Approach to Cytoreductive Nephrectomy in Metastatic Renal-Cell Carcinoma: Does Size Matter?

Abstract: Procedures with tumors larger than 10 cm were more likely to be converted to an open procedure. Tumors larger than 10 cm may be best approached via an open procedure, especially in the presence of involvement of adjacent organs or bulky lymphadenopathy.

Cited by 9 publications

References 10 publications

Minimally invasive radical nephrectomy: a contemporary review

Minimally invasive radical nephrectomy: a contemporary review

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

The Evolving Landscape of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma

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