Advanced‐stage renal cell carcinoma treated by radical nephrectomy and adjacent organ or structure resection

Abstract

OBJECTIVE To examine the effect of radical nephrectomy (RN) with adjacent organ and structure resection on survival, as invasion of adjacent organs in patients with renal cell carcinoma (RCC) is rare. PATIENTS AND METHODS After institutional review board approval, we reviewed our database and statistically analysed of patients with pathological stage T3 or T4 RCC who had RN and resection of a contiguous organ or structure. RESULTS We identified 38 patients of 2464 (1.5%) who had RN with adjacent organ or structure resection. The median (interquartile range) size of the mass was 11 (8–14) cm, and the follow‐up 13 (5–33) months. Most patients (68%) were pT4 stage and had conventional clear cell carcinoma (95%). Fourteen patients (37%) had positive surgical margins. The liver (10) was the most commonly resected adjacent organ or structure. Only one patient remains alive with no evidence of disease at 5 years, while three are currently alive with disease. Overall, 34 of 38 patients (90%) ultimately died from disease at a median (range) of 11.7 (5.4–29.2) months after surgical resection. The surgical margin status was the only statistically significant factor for recurrence and death (P = 0.006). CONCLUSIONS The prognosis for patients with advanced RCC and adjacent organ or structure involvement is extremely poor and similar to that of patients with metastatic disease. These patients should be thoroughly counselled about the impact of surgical management and considered for entry into neoadjuvant or adjuvant clinical trials with new targeted systemic agents.

Partial nephrectomy and enbloc liver resection using a bipolar radiofrequency device for renal cell carcinoma invading the liver

“…The patient was alive and well at 5 years 3. Karellas et al reported improved survival with extended resection 5. Applying bipolar radiofrequency energy to an electrode array can enable transmural excision of renal parenchyma in a bloodless way (figure 2B) without incurring system injury6 and without renal pedicle clamping 7.…”

Prognosticators and outcomes of patients with renal cell carcinoma and adjacent organ invasion treated with radical nephrectomy

“…As reflected in the 2010 AJCC TNM staging, patients with tumor extension beyond Gerota’s fascia are classified as stage IV, in the same category as patients with distant metastatic disease, consistent with generally poor outcome in these patients. Moreover, while targeted therapy has improved outcomes in patients with metastatic RCC, surgery remains the cornerstone for treatment of advanced RCC, and patients with suspected T4 RCC should not be routinely excluded from surgery [7]. We and others have shown in the past that in spite of a surgically challenging scenario, resection of the primary tumor in patients whose RCC shows adjacent organ invasion is feasible without significantly increased morbidity, and could provide improved survival in patients with no distant metastasis.…”

“…This subset of patients demonstrate poor outcomes with a 5-year survival rate of 20-30% and an estimated 10-year cancer specific survival rate (CSS) of 12% [5, 6]. Upfront aggressive surgery remains the standard of care for localized and locally advanced RCC and a cornerstone for the multimodal treatment of metastatic RCC [7, 8]. Nevertheless, tumors with adjacent organ involvement pose a challenging scenario even for experienced surgeons.…”

Resection of Pancreas and Duodenum During Radical Nephrectomy: Analysis of A Single Center Experience

“…Although 10 patients developed recurrence at a median time of 2.3 months, 5 (42%) patients were still alive at the time of analysis [7]. In another study of 26 patients at the Memorial Sloan Kettering Cancer Center (MSKCC), pancreas (23%) and bowel (23%) resections were among the more commonly resected organs, along with liver (39%), IVC (35%), vertebral body (31%), spleen (12%), and psoas muscle (7%); with 4 (15%) of those patients still alive at follow up [8].…”

“…Resection for locally advanced RCC has increasingly been performed with acceptable morbidity and mortality rates in the last few years [5,6], and there are some series describing such an aggressive approach with modest survival benefit in this group of patients [7,8]. Furthermore, clinical and pathological stage discrepancy is common in surgically treated patients which can have significant impact on clinical outcome [9].…”