Surgical management of advanced and metastatic renal cell carcinoma: A multidisciplinary approach

Brian M. Shinder, Kevin Rhee, Douglas Farrell, Nicholas J. Farber, Mark N. Stein, Thomas L. Jang, Eric A. Singer

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations

Abstract

The past decade has seen a rapid proliferation in the number and types of systemic therapies available for renal cell carcinoma. However, surgery remains an integral component of the therapeutic armamentarium for advanced and metastatic kidney cancer. Cytoreductive surgery followed by adjuvant cytokine-based immunotherapy (predominantly high-dose interleukin 2) has largely given way to systemic-targeted therapies. Metastasectomy also has a role in carefully selected patients. Additionally, neoadjuvant systemic therapy may increase the feasibility of resecting the primary tumor, which may be beneficial for patients with locally advanced or metastatic disease. Several prospective trials examining the role of adjuvant therapy are underway. Lastly, the first immune checkpoint inhibitor was approved for metastatic renal cell carcinoma (mRCC) in 2015, providing a new treatment mechanism and new opportunities for combining systemic therapy with surgery. This review discusses current and historical literature regarding the surgical management of patients with advanced and mRCC and explores approaches for optimizing patient selection.

Original languageEnglish (US)
Article number107
JournalFrontiers in Oncology
Volume7
Issue numberMAY
DOIs
StatePublished - May 31 2017

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Keywords

  • Cytoreductive nephrectomy
  • Cytoreductive partial nephrectomy
  • Lymphadenectomy
  • Metastasectomy
  • Neoadjuvant
  • Renal cell carcinoma
  • Targeted therapy

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