Nonradiological Treatment for Renal Tumors

  • Sarah P. Psutka
  • Brian H. Eisner


Traditionally, renal cell carcinoma (RCC) has been approached surgically via an open, flank approach with the goal of extirpation via nephrectomy. Recently, technical improvements stemming from a better understanding of the natural history of RCC have altered the approach to localized RCC, shifting treatment towards minimally invasive techniques and nephron-sparing surgery. Additionally, the benefit of cytoreductive surgery and metastasectomy has been realized in the era of antiangiogenic therapy for RCC. Herein, we review the most current trends in the surgical treatment of localized and metastatic RCC.


Renal Cell Carcinoma Renal Artery Inferior Vena Cava Renal Tumor Partial Nephrectomy 
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  1. 1.
    Lipworth L, Tarone RE, McLaughlin JK. The epidemiology of renal cell carcinoma. J Urol. 2006;176(6 Pt 1):2353–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Schwaibold HE, Stolzenburg JU. Laparoscopic partial nephrectomy. Arch Ital Urol Androl. 2009;81(2):72–5.PubMedGoogle Scholar
  3. 3.
    Butler BP, Novick AC, Miller DP, Campbell SA, Licht MR. Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology. 1995;45(1):34–40. discussion 40–1.PubMedCrossRefGoogle Scholar
  4. 4.
    Steinbach F, Stockle M, Muller SC, et al. Conservative surgery of renal cell tumors in 140 patients: 21 years of experience. J Urol. 1992;148(1):24–9. discussion 29–30.PubMedGoogle Scholar
  5. 5.
    Morgan WR, Zincke H. Progression and survival after renal-conserving surgery for renal cell carcinoma: experience in 104 patients and extended followup. J Urol. 1990;144(4):852–7. discussion 857–8.PubMedGoogle Scholar
  6. 6.
    Patel MN, Krane LS, Bhandari A, et al. Robotic partial nephrectomy for renal tumors larger than 4 cm. Eur Urol. 2010;57(2):310–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Makhoul B, De La Taille A, Vordos D, et al. Laparoscopic radical nephrectomy for T1 renal cancer: the gold standard? A comparison of laparoscopic vs open nephrectomy. BJU Int. 2004;93(1):67–70.PubMedCrossRefGoogle Scholar
  8. 8.
    Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol. 2010;183(2):473–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Licht MR, Novick AC, Goormastic M. Nephron sparing surgery in incidental versus suspected renal cell carcinoma. J Urol. 1994;152(1):39–42.PubMedGoogle Scholar
  10. 10.
    Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol. 2009;182(4):1271–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Bird VG, Shields JM, Aziz M, Ayyathurai R, De Los Santos R, Roeter DH. Laparoscopic radical nephrectomy for patients with T2 and T3 renal-cell carcinoma: evaluation of perioperative outcomes. J Endourol. 2009;23(9):1527–33.PubMedCrossRefGoogle Scholar
  12. 12.
    Gill IS, Kamoi K, Aron M, Desai MM. 800 laparoscopic partial nephrectomies: a single surgeon series. J Urol. 2010;183(1):34–41.PubMedCrossRefGoogle Scholar
  13. 13.
    Flum AS, Wolf Jr JS. Laparoscopic partial nephrectomy for multiple ipsilateral renal tumors using a tailored surgical approach. J Endourol. 2010;24(4):557–61.PubMedCrossRefGoogle Scholar
  14. 14.
    Clayman RV, Kavoussi LR, Figenshau RS, Chandhoke PS, Albala DM. Laparoscopic nephroureterectomy: initial clinical case report. J Laparoendosc Surg. 1991;1(6):343–9.PubMedCrossRefGoogle Scholar
  15. 15.
    Luo JH, Zhou FJ, Xie D, et al. Analysis of long-term survival in patients with localized renal cell carcinoma: laparoscopic versus open radical nephrectomy. World J Urol. 2010;28(3):289–93.PubMedCrossRefGoogle Scholar
  16. 16.
    Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol. 2007;178(1):41–6.PubMedCrossRefGoogle Scholar
  17. 17.
    Novick AC. Laparoscopic and partial nephrectomy. Clin Cancer Res. 2004;10(18 Pt 2):6322S–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Ganpule AP, Sharma R, Thimmegowda M, Veeramani M, Desai MR. Laparoscopic radical nephrectomy versus open radical nephrectomy in T1-T3 renal tumors: an outcome analysis. Indian J Urol. 2008;24(1):39–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Breda A, Finelli A, Janetschek G, Porpiglia F, Montorsi F. Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience. Eur Urol. 2009;55(4):836–50.PubMedCrossRefGoogle Scholar
  20. 20.
    Dekernion JB, Ramming KP, Smith RB. The natural history of metastatic renal cell carcinoma: a computer analysis. J Urol. 1978;120(2):148–52.PubMedGoogle Scholar
  21. 21.
    Mattar K, Finelli A. Expanding the indications for laparoscopic radical nephrectomy. Curr Opin Urol. 2007;17(2):88–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Sun M, Lughezzani G, Perrotte P, Karakiewicz PI. Treatment of metastatic renal cell carcinoma. Nat Rev Urol. 2010;7(6):327–38.PubMedCrossRefGoogle Scholar
  23. 23.
    de Reijke TM, Bellmunt J, van Poppel H, Marreaud S, Aapro M. EORTC-GU group expert opinion on metastatic renal cell cancer. Eur J Cancer. 2009;45(5):765–73.PubMedCrossRefGoogle Scholar
  24. 24.
    Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004;171(3):1071–6.PubMedCrossRefGoogle Scholar
  25. 25.
    Mickisch GH, Garin A, van Poppel H, de Prijck L, Sylvester R. European Organisation for Research and Treatment of Cancer (EORTC) Genitourinary Group. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358(9286):966–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345(23):1655–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Campbell SC, Flanigan RC, Clark JI. Nephrectomy in metastatic renal cell carcinoma. Curr Treat Options Oncol. 2003;4(5):363–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Kutikov A, Uzzo RG, Caraway A, et al. Use of systemic therapy and factors affecting survival for patients undergoing cytoreductive nephrectomy. BJU Int. 2010;106(2):218–23.PubMedCrossRefGoogle Scholar
  29. 29.
    Capitanio U, Jeldres C, Patard JJ, et al. Stage-specific effect of nodal metastases on survival in patients with non-metastatic renal cell carcinoma. BJU Int. 2009;103(1):33–7.PubMedCrossRefGoogle Scholar
  30. 30.
    Leibovich BC, Blute ML. Lymph node dissection in the management of renal cell carcinoma. Urol Clin North Am. 2008;35(4):673–8. viii.PubMedCrossRefGoogle Scholar
  31. 31.
    Blom JH, van Poppel H, Marechal JM, et al. Radical nephrectomy with and without lymph-node dissection: final results of European Organization for Research and Treatment of Cancer (EORTC) randomized phase 3 trial 30881. Eur Urol. 2009;55(1):28–34.PubMedCrossRefGoogle Scholar
  32. 32.
    Delacroix Jr SE, Wood CG. The role of lymphadenectomy in renal cell carcinoma. Curr Opin Urol. 2009;19(5):465–72.PubMedCrossRefGoogle Scholar
  33. 33.
    Margulis V, Wood CG. The role of lymph node dissection in renal cell carcinoma: the pendulum swings back. Cancer J. 2008;14(5):308–14.PubMedCrossRefGoogle Scholar
  34. 34.
    Wagner B, Patard JJ, Mejean A, et al. Prognostic value of renal vein and inferior vena cava involvement in renal cell carcinoma. Eur Urol. 2009;55(2):452–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Al Otaibi M, Youssif TA, Alkhaldi A, et al. Renal cell carcinoma with inferior vena caval extension: impact of tumour extent on surgical outcome. BJU Int. 2009;104(10):1467–70.PubMedCrossRefGoogle Scholar
  36. 36.
    Sagalowsky AI, Kadesky KT, Ewalt DM, Kennedy TJ. Factors influencing adrenal metastasis in renal cell carcinoma. J Urol. 1994;151(5):1181–4.PubMedGoogle Scholar
  37. 37.
    Kobayashi T, Nakamura E, Yamamoto S, et al. Low incidence of ipsilateral adrenal involvement and recurrences in patients with renal cell carcinoma undergoing radical nephrectomy: a retrospective analysis of 393 patients. Urology. 2003;62(1):40–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Pollak R, Prusak BF, Mozes MF. Anatomic abnormalities of cadaver kidneys procured for purposes of transplantation. Am Surg. 1986;52(5):233–5.PubMedGoogle Scholar
  39. 39.
    Turkvatan A, Ozdemir M, Cumhur T, Olcer T. Multidetector CT angiography of renal vasculature: normal anatomy and variants. Eur Radiol. 2009;19(1):236–44.PubMedCrossRefGoogle Scholar
  40. 40.
    Hernandez F, Ong AM, Rha KH, Pinto PA, Kavoussi LR. Laparoscopic renal surgery after spontaneous retroperitoneal hemorrhage. J Urol. 2003;170(3):749–51.PubMedCrossRefGoogle Scholar
  41. 41.
    Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009;56(4):625–34.PubMedCrossRefGoogle Scholar
  42. 42.
    Riggs SB, Larochelle JC, Belldegrun AS. Partial nephrectomy: a contemporary review regarding outcomes and different techniques. Cancer J. 2008;14(5):302–7.PubMedCrossRefGoogle Scholar
  43. 43.
    McNeil BK, Flanigan RC. Complications of open renal surgery. In: Loughlin KR, editor. Complications of urologic surgery and practice: diagnosis, prevention, and management. New York, NY: Informa Healthcare USA; 2007. p. 65.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of UrologyMassachusetts General HospitalBostonUSA

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