TY - JOUR
T1 - Role of metastasectomy in metastatic renal cell carcinoma
AU - Thomas, Arun Z.
AU - Adibi, Mehrad
AU - Borregales, Leonardo D.
AU - Wood, Christopher G.
AU - Karam, Jose A.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Purpose of review Management of patients with metastatic renal cell carcinoma is challenging and continues to be delivered in a multidisciplinary context. Even with the advent of systemic targeted therapy, complete remission with these new agents is rare using systemic therapy alone. Surgical resection of the primary tumor and metastatic deposits continues to play an important role in managing patients with metastatic renal cell carcinoma when aiming for complete remissions. To date, despite the lack of level 1 evidence, metastasectomy appears to prolong survival and achieve long-term cure in carefully selected patients. This review examines current evidence for the role of metastasectomy in renal cell carcinoma. Recent findings Studies continue to consistently support a benefit of complete metastasectomy for overall and cancerspecific survival at most sites for resection, with the exception of brain and bone, which tend to perform for symptomatic relief and palliation. Metastasectomy has not yet been examined in a randomized setting. The debate of survival benefit because of selection bias of patients or differences in tumor biology is relevant and has yet to be resolved in the literature. Clearly, careful patient selection remains paramount in optimizing survival benefit from metastasectomy. Summary Patients with isolated surgically resectable metastatic disease, with long disease-free intervals, and with good performance status are likely to benefit the most from metastasectomy.
AB - Purpose of review Management of patients with metastatic renal cell carcinoma is challenging and continues to be delivered in a multidisciplinary context. Even with the advent of systemic targeted therapy, complete remission with these new agents is rare using systemic therapy alone. Surgical resection of the primary tumor and metastatic deposits continues to play an important role in managing patients with metastatic renal cell carcinoma when aiming for complete remissions. To date, despite the lack of level 1 evidence, metastasectomy appears to prolong survival and achieve long-term cure in carefully selected patients. This review examines current evidence for the role of metastasectomy in renal cell carcinoma. Recent findings Studies continue to consistently support a benefit of complete metastasectomy for overall and cancerspecific survival at most sites for resection, with the exception of brain and bone, which tend to perform for symptomatic relief and palliation. Metastasectomy has not yet been examined in a randomized setting. The debate of survival benefit because of selection bias of patients or differences in tumor biology is relevant and has yet to be resolved in the literature. Clearly, careful patient selection remains paramount in optimizing survival benefit from metastasectomy. Summary Patients with isolated surgically resectable metastatic disease, with long disease-free intervals, and with good performance status are likely to benefit the most from metastasectomy.
KW - Metastasectomy
KW - Metastases
KW - Renal cell carcinoma
UR - http://www.scopus.com/inward/record.url?scp=84942571080&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84942571080&partnerID=8YFLogxK
U2 - 10.1097/MOU.0000000000000196
DO - 10.1097/MOU.0000000000000196
M3 - Review article
C2 - 26125508
AN - SCOPUS:84942571080
SN - 0963-0643
VL - 25
SP - 381
EP - 389
JO - Current opinion in urology
JF - Current opinion in urology
IS - 5
ER -