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Renal Cancer pp 295-305 | Cite as

Role of Surgery in Locally Recurrent and Metastatic Renal Cancer

  • Andrew G. McIntosh
  • Eric C. Umbreit
  • Christopher G. WoodEmail author
Chapter

Abstract

Locally recurrent renal cell carcinoma following either partial or radical nephrectomy presents a complex set of technical and therapeutic challenges to clinicians. That there is a role for aggressive surgical resection in these clinical scenarios is clear. Retrospective evidence demonstrates the feasibility of salvage surgery and the potential benefit to oncologic outcomes. However, clear trade-offs exist between the possible oncologic benefits of surgical extirpation and the high-risk nature of salvage renal surgery. Similarly, local recurrence following primary ablative therapy can be challenging to diagnose on cross-sectional imaging, and salvage surgery is technically demanding. Verification of local recurrence in this situation is critical prior to embarking upon surgical intervention. Additionally, metastatic disease presents unique and complex challenges of its own. Metastasectomy has been demonstrated to have a role in the management of these patients but again must be undertaken with a clear understanding of the risks of surgery. Several retrospective series have demonstrated excellent survival in well-selected patients undergoing surgical management of metastatic disease. Broadly speaking, appropriate patient selection and risk evaluation are paramount to successful surgical management of both locally recurrent disease and metastatic disease. As the contemporary era of targeted therapy and immunotherapy continues to evolve, further evaluation of the role and timing of surgery will be necessary to infer meaningful standards of care.

Keywords

Renal cell carcinoma Recurrence Salvage surgery Metastasis Metastasectomy Partial nephrectomy Radical nephrectomy Ablation 

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Andrew G. McIntosh
    • 1
  • Eric C. Umbreit
    • 1
  • Christopher G. Wood
    • 1
    Email author
  1. 1.Department of UrologyUniversity of Texas MD Anderson Cancer CenterHoustonUSA

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