Role of surgery in patients with metastatic renal cell carcinoma
- Jerome P Richie, MD, FACS
Jerome P Richie, MD, FACS
- Section Editor — Cancer of the Urethra, Penis, and Ureter; Urologic Surgery; Prostate Cancer
- Elliott Carr Cutler Professor of Surgery
- Harvard Medical School
- Toni K Choueiri, MD
Toni K Choueiri, MD
- Director, The Lank Center for Genitourinary Oncology
- Dana-Farber Cancer Institute and Brigham and Women's Hospital
- Associate Professor of Medicine
- Harvard Medical School
Patients who present with metastatic renal cell carcinoma (RCC) or who develop metastases or recurrent disease following prior treatment are generally managed with systemic therapy, primarily using immunotherapy or agents targeting the vascular endothelial growth factor (VEGF) pathways. However, not all patients with metastatic RCC behave similarly; some data suggest that there may be a subgroup whose tumors will display an indolent growth pattern that may warrant careful surveillance rather than active surgical or medical therapy . Regardless, most patients with metastatic RCC will require treatment, and surgery is sometimes part of the therapeutic plan.
This topic will discuss the role of surgery in patients with metastatic RCC. Other topics relevant to this population are discussed separately. (See "Overview of the treatment of renal cell carcinoma", section on 'Advanced RCC'.)
OVERVIEW OF SURGICAL TREATMENT FOR METASTATIC RENAL CELL CARCINOMA
Surgery continues to play an important role in the management of patients with metastatic renal cell carcinoma (RCC) in one of several ways (algorithm 1):
●A nephrectomy can be performed as part of a combined modality approach in order to decrease the bulk of tumor prior to systemic therapy (see 'Nephrectomy' below)
●Metastasectomy, in patients with one or a very limited number of metastases (see 'Metastasectomy' below)
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- OVERVIEW OF SURGICAL TREATMENT FOR METASTATIC RENAL CELL CARCINOMA
- Patient selection
- Role of cytoreductive nephrectomy in the era of molecularly-targeted agents
- Patient selection
- Organ-specific considerations
- - Lung metastases
- - Isolated bone metastases
- - Brain metastases
- - Liver metastases
- - Thyroid metastases
- - Pancreatic metastases
- - Local recurrence
- Role of systemic therapy
- Residual disease after systemic therapy
- PALLIATIVE NEPHRECTOMY
- SUMMARY AND RECOMMENDATIONS