Kidney Cancer Research Network of Canada (KCRNC) consensus statement on the role of cytoreductive nephrectomy for patients with metastatic renal cell carcinoma

Abstract

Mason et al KCRNC consensus: Cytoreductive nephrectomy for mRCC several important questions remain surrounding the appropriate application of CN, particularly with regards to optimal patient selection and the timing of surgery.Herein, the Kidney Cancer Research Network of Canada (KCRNC) provides consensus recommendations on the role of CN in patients with mRCC in order to guide clinicians who manage patients with advanced RCC. Methods Evidence acquisitionA comprehensive search was conducted to identify studies relevant to the development of this consensus statement. Databases searched included MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SCOPUS. The search strategy was designed and conducted by an experienced librarian with input from the consensus statement authors. The full search strategy can be found in the appendix. Consensus statement developmentThis consensus document was developed to address six questions related to CN that were judged to be the most relevant to patient care:1) Should patients with mRCC be offered CN and what is the optimal patient selection and timing? 2) Is there a role for CN in patients with non-clear cell mRCC? 3) Is there a role for biopsy prior to CN? 4) Is there a role for concomitant regional lymph node dissection during CN? 5) Is there a preferred surgical approach for CN? The statements contained herein were developed by consensus of the authors of this document, which include stakeholders across multiple specialties. CUAJ -Consensus StatementMason et al KCRNC consensus: Cytoreductive nephrectomy for mRCC Should patients with metastatic renal cell carcinoma be offered cytoreductive nephrectomy and what is the optimal patient selection and timing?

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

“…Notably, under any circumstances, patient selection and timing of surgery critically impact on nephrectomy benefits in metastatic RCC patients [ 33 , 35 ]. Most often, patients with poor health status are unlikely to benefit from nephrectomy [ 38 ]. On the other side, patients with good performance status, minimal symptoms related to metastases, a resectable primary tumor, and a limited burden of metastatic disease are likely to highly benefit from the surgery [ 38 ].…”

“…Most often, patients with poor health status are unlikely to benefit from nephrectomy [ 38 ]. On the other side, patients with good performance status, minimal symptoms related to metastases, a resectable primary tumor, and a limited burden of metastatic disease are likely to highly benefit from the surgery [ 38 ]. One systematic review also found that rigorously selected patients based on prognostic factors, with less metastasis, and those displaying favorable responses to initial systemic therapy could highly benefit from nephrectomy [ 39 ].…”

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

“…Of note, in any case, careful patient selection and timing of surgery were critical in determining whether metastatic RCC patients would bene t from nephrectomy [27,29]. Commonly, patients with poor health status were unlikely to bene t from nephrectomy [32]. Patients with good performance status, minimal symptoms related to metastases, a resectable primary tumor, and a limited burden of metastatic disease might be good candidates for surgery [32].…”

“…Commonly, patients with poor health status were unlikely to bene t from nephrectomy [32]. Patients with good performance status, minimal symptoms related to metastases, a resectable primary tumor, and a limited burden of metastatic disease might be good candidates for surgery [32]. A systematic review also indicated nephrectomy was bene cial to patients with limited burden of metastasis, well-selected patients based on established prognostic factors, and patients with favorable response for initial systemic therapy [33].…”

Development and validation of a nomogram to predict overall survival for patients with metastatic renal cell carcinoma

“…Notably, under any circumstances, patient selection and timing of surgery critically impact on nephrectomy bene ts in metastatic RCC patients [33,35]. Most often, patients with poor health status are unlikely to bene t from nephrectomy [38]. On the other side, patients with good performance status, minimal symptoms related to metastases, a resectable primary tumor, and a limited burden of metastatic disease are likely to highly bene t from the surgery [38].…”