Limits of surgery in metastatic kidney cancer

04 October 2015

Not all patients with advanced kidney cancer would benefit from nephrectomy, prompting experts to consider other less radical or aggressive options such as partial nephrectomy or lymph node dissection.

“Partial nephrectomy should be considered standard of care whenever possible even in cases of metastatic disease,” said C. Gingu (RO) who examined the issue in the concluding sessions of the 15th Central European Meeting held over the weekend in Budapest, Hungary.

Gingu cited recent studies that explored options such as lymph node dissection (LND) for patients with metastatic disease. He presented cases from his own practice where he conducted LND to gain some survival advantages. He also looked into the issue of metastasectomy when there is poor response to treatment of metastatic kidney cancer.

According to Gingu, metastatic renal cell carcinoma (mRCC )is a difficult condition to treat, requiring multimodal therapy involving an experienced multidisciplinary team.

He also noted that patients with good progression survival and oligometastatic resectable disease are good candidates for an aggressive surgical approach.

“There is hope for mRCC patients to be cured through metastasectomy,” he said, adding that the shift towards metastasectomy instead of immediate systemic therapy for lung metastasis patients must be considered.

In another overview lecture, Z. Kastelan (HR) looked in the option of active surveillance in patients with small renal masses (SRMs).

“Active surveillance is a safe and reasonable option for patients with renal tumors smaller than 4cm (cT1a) and with competing health risks,” he said.

He also noted that SRMs have a slow growth rate and that progression to metastasis is rare.