Surgical treatment for renal cell carcinoma

Systemic therapies for renal cell carcinoma have made modest improvements in patient survival but rarely offer durable cure. Thus, surgical excision of renal cell carcinoma is an integral component of oncologic management. The spectrum of renal cell carcinoma presentation from small renal masses, locally advanced disease, and in the presence of metastasis varies with the surgical armamentarium needed to treat this diverse group of patients. In general for small renal masses, a nephron-sparing approach is preferred if it can be completed safely with negative margins, and for locally advanced tumors, radical nephrectomy is preferred with excision of the affected kidney, lymph nodes, and venous thrombi if present. With metastatic disease, cytoreductive nephrectomy has been shown to prolong survival in carefully selected patients, usually with good performance status and with oligometastasis. The surgical nuances, indication, and motivation for each surgical technique will be discussed in this chapter.