Skip to main content

Advertisement

SpringerLink
Log in

Nephrectomy in metastatic renal cell carcinoma

  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Patients presenting with metastatic renal cell carcinoma (RCC) face a dismal prognosis, with a median survival time of only 6 to 12 months and a 2-year survival rate of 10% to 20%. RCC is notoriously chemorefractory, and immunotherapy is associated with total response rates of less than 20% and complete response rates of less than 5%. Therefore, surgery has continued to play a prominent role in the management of patients with metastatic RCC. Recent randomized prospective trials suggest a survival advantage for cytoreductive nephrectomy, and some patients with advanced RCC may also achieve palliation. Patients with limited and resectable metastases should be considered for combined nephrectomy and metastasectomy. The other main option for patients with advanced RCC is systemic immunotherapy followed by assessment for surgical consolidation, but responses in the primary tumor are uncommon and results with this pathway have not been encouraging. Tumor embolization can be a valuable palliative adjunct for some patients with metastatic RCC. Cytoreductive nephrectomy represents the most aggressive pathway for patients with metastatic RCC. Although cytoreductive nephrectomy can extend survival by approximately 50% for many patients, it can be associated with morbidity and delay in administration of systemic therapy. Therefore, patient selection, taking into account performance status and sites and burden of disease, which are well-established prognostic factors for patients with metastatic RCC, is of paramount importance in managing this challenging group of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Flanigan RC, Yonover PM, Campbell SC: Role of nephrectomy in metastatic renal cell carcinoma. Am Urol Assoc Update Ser 2002, 21:242–247. A comprehensive review of the role of surgery in the management of patients with metastatic RCC.

    Google Scholar 

  2. Gottesman JE, Crawford ED, Grossman HS, et al.: Infarction: nephrectomy for metastatic renal cell carcinoma. Urology 1985, 25:248.

    Article  PubMed  CAS  Google Scholar 

  3. Figlin RA, Thompson JA, Bukowski RM, et al.: Multicenter, randomized, phase III trial of CD8+ tumorinfiltrating lymphocytes in combination with recombinant interleukin-2 in metastatic renal cell carcinoma. J Clin Oncol 1999, 17:2521–2529.

    PubMed  CAS  Google Scholar 

  4. Kavolius DP, Mastorakos C, Pavlovich P, et al.: Resection of metastatic renal cell carcinoma. J Clin Oncol 1998, 16:2261–2266. One of the largest series reporting outcomes for metastasectomy for patients with RCC.

    PubMed  CAS  Google Scholar 

  5. 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. A randomized prospective trial evaluating the role of cytoreductive nephrectomy for patients with metastatic RCC.

    Article  PubMed  CAS  Google Scholar 

  6. Mickisch GH, Garin A, van Poppel H, et al.: Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal cell carcinoma. Lancet 2001, 358:966–970. A European Organization for Research and Treatment of Cancer trial involving cytoreductive nephrectomy, with a similar study design as the SWOG trial.

    Article  PubMed  CAS  Google Scholar 

  7. Fleischmann JD, Kim B: Interleukin-2 immunotherapy followed by resection of residual renal cell carcinoma. J Urol 1991, 145:938–941.

    PubMed  CAS  Google Scholar 

  8. Wagner JR, McClellan M, Linehan WM: Interleukin-2 based immunotherapy for metastatic renal cell carcinoma with the kidney in place. J Urol 1999, 162:43–45. A paper reporting the results of immunotherapy with primary tumor left in situ, with subsequent attempts at surgical consolidation. This is one of the largest studies reported.

    Article  PubMed  CAS  Google Scholar 

  9. Elson PJ: Prognostic factors in metastatic renal cell carcinoma. In Current Clinical Oncology. Renal Cell Carcinoma: Molecular Biology, Immunology and Clinical Management. Edited by Bukowski RM, Novick AC. Totowa: Humana Press; 2000:147–160. An excellent review of the prognostic factors for patients with metastatic RCC.

    Google Scholar 

  10. Zisman A, Pantuck AJ, Wieder J, et al.: Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol 2002, 20:4559–4566. State-of-the-art integrated staging system for RCC that improves prognostication and provides useful estimates of survival.

    Article  PubMed  Google Scholar 

  11. Bui MH, Seligson D, Han KR, et al.: Carbonic anhydrase IX is an independent predictor of survival in advanced renal celar cell carcinoma: implications for prognosis and therapy. Clin Cancer Res 2003, 9:802–811.

    PubMed  CAS  Google Scholar 

  12. Novick AC, Campbell SC: Renal tumors. Campbell's Urology. Edited by Walsh PC, Retik AB, Vaughan ED Jr. Philadelphia: W B Saunders; 2002:2672–2731.

    Google Scholar 

  13. Pantuck AJ, Belldegrun AS, Figlin RA: Nephrectomy and interleukin-2 for metastatic renal cell carcinoma. N Engl J Med 2001, 345:1711–1712.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

    Article  PubMed  CAS  Google Scholar 

  15. Zisman A, Wieder JA, Pantuck AJ, et al.: Renal cell carcinoma with tumor thrombus extension: biology, role of nephrectomy and response to immunotherapy. J Urol 2003, 169:909–916.

    Article  PubMed  Google Scholar 

  16. Slaton JW, Perrotte P, Balbay MD, et al.: Reassessment of the selection criteria for cytoreductive nephrectomy in patients with metastatic renal cell carcinoma. J Urol 2000, 163(Suppl 4):79.

    Google Scholar 

  17. Wood CG, Huber N, Madsen L, et al.: Clinical variables that predict survival following cytoreductive nephrectomy for metastatic renal cell carcinoma. J Urol 2001, 165(Suppl 5):184.

    Google Scholar 

  18. Fallick ML, McDermott DF, LaRock D, et al.: Nephrectomy before interleukin-2 therapy for patients with metastatic renal cell carcinoma. J Urol 1997, 158:1691–1695.

    Article  PubMed  CAS  Google Scholar 

  19. Kierney PC, van Heerden JA, Segura JW, et al.: Surgeon's role in the management of solitary renal cell carcinoma metastases occurring subsequent to initial curative nephrectomy: an institutional review. Ann Surg Oncol 1994, 1:345–352.

    Article  PubMed  CAS  Google Scholar 

  20. Tolia BM, Whitmore WF Jr: Solitary metastasis from renal cell carcinoma. J Urol 1975, 114:836–838.

    PubMed  CAS  Google Scholar 

  21. DeKernion JB, Lindner A: Treatment of advanced renal cell carcinoma. Prog Clin Biol Res 1982, 100:641–659.

    PubMed  CAS  Google Scholar 

  22. Motzer R, Russo P: Systemic therapy for renal cell carcinoma. J Urol 2000, 163:408–417. An excellent review of systemic therapy for patients with metastatic RCC.

    Article  PubMed  CAS  Google Scholar 

  23. Montie JE, Stewart BH, Straffon RA: The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma. J Urol 1977, 117:272–275.

    PubMed  CAS  Google Scholar 

  24. Krishnamurthi V, Novick AC, Bukowski RM, et al.: Efficacy of multimodality therapy in advanced renal cell carcinoma. Urology 1998, 51:933–937.

    Article  PubMed  CAS  Google Scholar 

  25. Kim B, Louie AC: Surgical resection following interleukin- 2 therapy for metastatic renal cell carcinoma prolongs remission. Arch Surg 1992, 127:1343–1349.

    PubMed  CAS  Google Scholar 

  26. Childs R, Chernoff A, Contentin N, et al.: Regression of metastatic renal cell carcinoma after nonmyeloablative allogeneic peripheral blood stem cell transplantation. N Engl J Med 2000, 343:750–758. An initial report regarding the use of stem cell transplant for the treatment of patients with metastatic RCC.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The Cardinal Bernardin Cancer Center, Loyola University Medical Center, Hines VA Hospital, 2160 South 1st Avenue, Building 54, Room 237, 60153, Maywood, IL, USA

    Steven C. Campbell MD, PhD

Authors
  1. Steven C. Campbell MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert C. Flanigan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph I. Clark MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Campbell, S.C., Flanigan, R.C. & Clark, J.I. Nephrectomy in metastatic renal cell carcinoma. Curr. Treat. Options in Oncol. 4, 363–372 (2003). https://doi.org/10.1007/s11864-003-0037-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-003-0037-4

Keywords

Search

Navigation