Surgery for metastatic renal cell cancer

Shomik Sengupta, Bradley C. Leibovich, Michael L. Blute, Horst Zincke

Research output: Contribution to journalReview ArticleResearchpeer-review

12 Citations (Scopus)

Abstract

Renal cell carcinoma (RCC) often presents in its metastatic form, or progresses after curative treatment. While the management of metastatic RCC has historically been mainly surgical, contemporary approaches often incorporate systemic immunotherapy. This review examines the current indications and scope of surgical treatment of patients with metastatic RCC. Surgery is sometimes indicated for symptom palliation at either the primary or secondary sites. However, other less invasive therapies may be equally effective, and should be considered carefully. Cytoreductive surgery prior to immunotherapy appears to confer a survival advantage, but only selected patients are suitable for this treatment regimen. Primary immunotherapy followed by surgical removal of the tumour in partial responders is an alternative treatment strategy, which has not yet been evaluated as in randomized trials. As immunotherapy develops further, the precise timing and role of surgery in multimodality treatment will need to be carefully evaluated. Occasionally, the complete surgical excision of metastases, and the primary tumour, if present, is feasible and this may prolong survival. Empirically, it would seem that such patients should also be treated with adjuvant immunotherapy, as eventual relapse is frequent. Surgery with the aim of inducing spontaneous tumour regression is not justifiable, given the rarity of this phenomenon.

Original languageEnglish
Pages (from-to)155-160
Number of pages6
JournalWorld Journal of Urology
Volume23
Issue number3
DOIs
Publication statusPublished - 1 Jul 2005
Externally publishedYes

Keywords

  • Carcinoma
  • Metastasis
  • Neoplasm
  • Nephrectomy
  • Renal cell
  • Surgery

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