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Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma

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New Paradigms for Cytoreductive Nephrectomy.

Benjamin J Lichtbroun¹, Arnav Srivastava¹, Sai Krishnaraya Doppalapudi¹

¹Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, 195 Little Albany Street Room 4563, New Brunswick, NJ 08901, USA.

|June 10, 2022

Summary

The role of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) treatment is evolving with new immunotherapy (IO) agents. Current data suggests CN may offer clinical benefits alongside IO therapies, with ongoing trials to clarify its role.

Keywords:

cytoreductive nephrectomy cytoreductive surgery immune-oncologic agents immunotherapy metastatic renal cell carcinoma renal cell carcinoma

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Area of Science:

Oncology
Nephrology
Immunotherapy

Background:

Cytoreductive nephrectomy (CN) has a historical role in metastatic renal cell carcinoma (mRCC) treatment.
The emergence of immuno-oncologic (IO) agents has significantly altered the treatment landscape for RCC.
The precise role of CN in combination with modern IO therapies remains uncertain.

Purpose of the Study:

To review the existing literature on the role of CN in mRCC treatment.
To evaluate the potential benefits of CN in the context of contemporary immunotherapy regimens.
To identify the impact of IO agents on the historical role of CN in mRCC management.

Main Methods:

Systematic review of published articles examining CN in mRCC.
Analysis of studies considering CN both historically and in the era of immunotherapy.
Evaluation of preliminary data from ongoing clinical trials investigating CN combined with IO.

Main Results:

While large-scale clinical trials are pending, current data suggests a promising role for CN in improving clinical outcomes.
Early findings indicate that CN may provide clinical benefit when used in conjunction with immuno-oncologic agents.
The combination of CN and IO therapies is an active area of clinical research.

Conclusions:

The role of cytoreductive nephrectomy in metastatic renal cell carcinoma is being re-evaluated in the age of immunotherapy.
Preliminary evidence suggests that CN may remain a valuable treatment option, potentially enhancing the efficacy of IO agents.
Ongoing clinical trials are crucial for definitively establishing the role of CN in combination with modern cancer therapies.