Role of Surgery in RCC

Localized RCC

• Robson and colleagues (1969) established radical nephrectomy as the “gold standard” curative operation for localized RCC with their report of 66% and 64% overall survival for stages I and II tumors, respectively.

• Surgery is the only curative therapy for stage I-III

• Radial nephrectomy is gold standard• Partial nephrectomy in selected patients

LOCALLY ADVANCED RENAL CELL CARCINOMA

• Approximately 45% to 70% of patients with RCC and IVC thrombus can be cured with an aggressive surgical approach including radical nephrectomy and IVC thrombectomy

METASTATIC RENAL CELL CARCINOMA

• Nephrectomy Paliative• Hormonal Therapy• Chemotherapy • Radiation Therapy • Cytokines and Immunologic Therapy • Multimodal Therapy

Cytoreductive nephrectomy• Initially, the rationale for nephrectomy included palliation for

severe bleeding, pain, and paraneoplastic symptoms, symptoms related to bulkiness of disease including pain, nausea, or GI obstruction

• The median survival in the nephrectomy-interferon group was found to be 13.6 months (95% CI, 9.7 to 17.4) versus 7.8 months (95% CI, 5.9 to 9.7) for patients receiving interferon alfa alone (HR, 0.69; 95% CI, 0.55 to 0.87; P = .002).

• However, nonsurgical options are often effective in palliating symptoms associated with RCC; cytoreductive nephrectomy is hence infrequently performed with purely palliative intent.

Interferon alfa Monotherapy or Interferon alfa with Cytoreductive Nephrectomy: Metastatic Renal Cell Carcinoma

Reference

• Cambell and Walsh Urology 10th edition 2011 Chapter 45, page 1449 - 1478