Abstract
Renal cell carcinoma (RCC) is a life-threatening disease with a significant health burden to society. In 2001, there were an estimated 12,100 deaths from RCC in the United States (1). Presentation with advanced kidney cancer occurs in approximately one-third of patients (2) leading to significant morbidity and mortality. The use of systemic immunotherapy affords this patient population the best chance at survival, although various trials have demonstrated suboptimal response rates (3,4). Results of recent studies from single institutions and two multicenter randomized trials suggest a survival benefit for patients who underwent cytoreductive nephrectomy followed by some form of systemic immunotherapy (5–7). Unfortunately, many patients are not fit to receive systemic immunotherapy following surgery. In an effort to decrease morbidity from the procedure and to increase the number of patients fit for systemic treatment, the National Cancer Institute (NCI) group began performing cytoreductive laparoscopic radical nephrectomies (LRNs) in appropriate candidates. Herein, we describe the procedure and the early outcomes.
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References
American Cancer Society. Cancer Facts and Figures; 2001.
Hock LM, Lynch J, Balaji KC. Increasing incidence of kidney cancer in the last 2 decades in the United States: An analysis of surveillance, epidemiology and end results program data. J Urol 2002; 167: 57–60.
Fyfe G, Fisher RI, Rosenberg SA, et al. Results of treatment of 255 patients with metastastic renal cell carcinoma who received high-dose recombinant interleukin2 therapy. J Clin Oncol 1995; 13: 688–696
Figlin RA. Renal cell carcinoma: Management of advanced disease. J Urol 1999; 161: 381–387.
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: 1655–1659.
Mickisch GHJ, Garin A, van Poppel H, et al. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomized trial. Lancet 2001; 358: 966–970.
Walther MM, Yang JC, Pass HI, et al. Cytoreductive surgery before high dose interleukin-2 based therapy in patients with metastatic renal cell carcinoma. J Urol 1997; 158: 1675–1678.
Cerfolio RJ, Allen MS, Deschamps C, et al. Pulmonary resection of metastatic renal cell carcinoma. Ann Thorac Surg 1994; 57: 339–344.
Friedel G, Hürtgen M, Penzenstadler M, Kyriss T, Toomes H. Resection of pulmonary metastases from renal cell carcinoma. Anticancer Res 1999; 19: 1593–1596.
Wagner JR, Walther MM, Linehan WM, et al. Interleukin-2 based immunotherapy for metastatic renal cell carcinoma with the kidney in place. J Urol 1999; 162: 43–45.
Pautler SE, Richards C, Libutti SK, Linehan WM, Walther MM. Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy. J Urol 2002; 167: 48–50.
Dunn MD, Partis AJ, Shalhav AL, et al. Laparoscopic versus open radical nephrectomy: A 9-year experience. J Urol 2000; 164: 1153–1159.
Savage SJ, Gill IS: Laparoscopic radical nephrectomy for renal cell carcinoma in a patient with level I renal vein thrombus. J Urol 2000; 163: 1243–1244.
Sundaram CP, Rehman J, Landman J, Oh J. Hand assisted laparoscopic radical nephrectomy for renal cell carcinoma with inferior vena caval thrombus. J Urol 2002; 168: 176–179.
Pautler SE, McWilliams GW, Harrington FS, Walther MM. An articulating retractor holder to facilitate laparoscopic adrenalectomy and nephrectomy. J Urol 2001: 166:198–199.
Dunn MD, McDougall EM, Clayman RV. Laparoscopic radical nephrectomy. J Endourol 2000; 14: 849–855.
Rehman J, Landman J, Kerbl K, Clayman RV. Laparoscopic repair of diaphragmatic defect by total intracorporeal suturing: Clinical and technical considerations. J Soc Lap Surg 2001; 5: 287–291.
Walther MM, Lyne JC, Libutti SK, Linehan WM. Laparoscopic cytoreductive nephrectomy as preparation for administration of systemic interleukin-2 in the treatment of metastatic renal cell carcinoma: A pilot study. Urology 1999; 53: 496–501.
Pautler SE, Harrington FS, McWilliams GW, Walther MM. A novel laparoscopic specimen entrapment device to facilitate morcellation of large renal tumors. Urology 2002; 59: 591–593.
Sundaram CP, Ono Y, Landman J, Rehman J, Clayman RV. Hydrophilic guide wire technique to facilitate organ entrapment using a laparoscopic sack during laparoscopy. J Urol 2002; 167: 1376–1377.
Levy DA, Swanson DA, Slaton JW, Ellerhorst J, Dinney CPN. Timely delivery of biological therapy after cytoreductive nephrectomy in carefully selected patients with metastatic renal cell carcinoma. J Urol 1998; 159:1168–1173.
Walther MM, Alexander RB, Wiess GH, et al. Cytoreductive surgery prior to interleukin-2-based therapy in patients with metastatic renal cell carcinoma. Urology 1993; 42: 250–257.
Flanigan RC, Yonover PM. The role of radical nephrectomy in metastatic renal cell carcinoma. Sem Urol Oncol 2001; 19: 98–102.
Rackley R, Novick A, Klein E, Bukowski R, McLain D, Goldfarb D. The impact of adjuvant nephrectomy on multimodality treatment of metastatic renal cell carcinoma. J Urol 1994; 152: 1399–1403.
Bennett RT, Lerner SE, Taub HC, Dutcher JP, Fleischmann J. Cytoreductive surgery for stage IV renal cell carcinoma. J Urol 1995; 154: 32–34.
Franklin JR, Figlin R, Rauch J, Gitlitz B, Belldegrun A. Cytoreductive surgery in the management of metastatic renal cell carcinoma: the UCLA experience. Sem Urol Oncol 1996; 14: 230–236.
Vasselli JR, Yang JC, Linehan WM, et al. Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. J Urol 2001; 166: 68–72.
Savage SJ, Gill IS. Intact specimen extraction during renal laparoscopy: musclesplitting versus muscle-cutting incision. J Endourol 2001;15: 165–169.
Pautler SE, Hewitt SM, Linehan WM, Walther MM. Specimen morcellation after laparoscopic radical nephrectomy: Confirmation of histological diagnosis using needle biopsy. J Endourol 2002; 16: 89–92.
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Pautler, S.E., Walther, M.M. (2004). Role of Laparoscopic Nephrectomy in Metastatic Renal Cell Carcinoma. In: Cadeddu, J.A. (eds) Laparoscopic Urologic Oncology. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-425-2_2
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DOI: https://doi.org/10.1007/978-1-59259-425-2_2
Publisher Name: Humana Press, Totowa, NJ
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Online ISBN: 978-1-59259-425-2
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