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Nephrectomy in metastatic renal cell carcinoma
Steven C Campbell1, Robert C Flanigan, Joseph I Clark
1Department of Urology, The Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines VA Hospital, 2160 South 1st Avenue, Building 54, Room 237, Maywood, IL 60153, USA. scampb6@lumc.edu
Current Treatment Options in Oncology
|August 28, 2003
Summary
Metastatic renal cell carcinoma (RCC) has a poor prognosis. Cytoreductive nephrectomy may improve survival by 50% but requires careful patient selection due to potential morbidity and delayed systemic therapy.
Area of Science:
- Oncology
- Surgical Oncology
Background:
- Metastatic renal cell carcinoma (RCC) presents a poor prognosis, with limited survival rates and low response to chemotherapy and immunotherapy.
- Surgery remains a significant treatment modality for metastatic RCC, offering palliative benefits and potential survival advantages.
Purpose of the Study:
- To review the role of surgical interventions, including cytoreductive nephrectomy and metastasectomy, in managing patients with metastatic RCC.
- To discuss the benefits, risks, and patient selection criteria for cytoreductive nephrectomy in advanced RCC.
Main Methods:
- Review of recent randomized prospective trials and established prognostic factors for metastatic RCC.
- Analysis of surgical options such as cytoreductive nephrectomy, combined nephrectomy and metastasectomy, and palliative tumor embolization.
Main Results:
- Cytoreductive nephrectomy may extend survival by approximately 50% in select patients with metastatic RCC.
- Combined nephrectomy and metastasectomy is a viable option for patients with limited, resectable metastases.
- Systemic immunotherapy followed by surgical consolidation has shown limited success in primary tumor response.
Conclusions:
- Cytoreductive nephrectomy is an aggressive but potentially survival-extending option for metastatic RCC, necessitating careful patient selection based on performance status and disease burden.
- Surgical management, including cytoreductive nephrectomy and metastasectomy, plays a crucial role in improving outcomes for carefully selected patients with metastatic renal cell carcinoma.