Controversies in the Surgical Management of Renal Cancer

Authors: Michael P. Porter MD 1 and Paul H. Lange MD 1
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  • 1 Department of Urology, University of Washington College of Medicine, Seattle, Washington
Volume/Issue:
Volume 3: Issue 1
Online Publication Date:
Jan 2005
DOI:
https://doi.org/10.6004/jnccn.2005.0005
Full access

Renal tumors are a common cause of cancer, and renal cell carcinoma accounts for the vast majority of the renal tumors in the United States. The past two decades have produced numerous advances in the treatment of localized and metastatic renal cell carcinoma. Nephron-sparing surgery, laparoscopic nephrectomy, and energy-ablative techniques are now in the armamentarium of the urologist. The role of adrenalectomy and lymphadenectomy are better understood today than in decades past, and recent advances in the understanding of immunotherapy, cytoreductive nephrectomy, and metastatic disease have also improved treatment for this disease. As is often the case as technology and knowledge evolve, controversies regarding the surgical treatment of renal cancer exist. This article outlines some of these controversies and reviews the evidence surrounding each.

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Correspondence: Michael P. Porter, MD, H220 Health Sciences Center, Box 357183, Seattle, WA 98195. E-mail: mporter@u.washington.edu
  • 1

    Ries Lag EM, Kosary CL, Hankey BF. (eds). SEER Cancer Statistics Review, 1975-2001. Bethesda, MD: National Cancer Institute; 2004.

  • 2

    Patard JJ, Shvarts O, Lam JS. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 2004;171(6 Pt 1):2181–2185; quiz 2435.

    • Search Google Scholar
    • Export Citation
  • 3

    Stephenson AJ, Chetner MP, Rourke K. Guidelines for the surveillance of localized renal cell carcinoma based on the patterns of relapse after nephrectomy. J Urol 2004;172:58–62.

    • Search Google Scholar
    • Export Citation
  • 4

    Vermooten V. Indications for conservative surgery in certain renal tumors: Study based on growth pattern of clear cell carcinoma. J Urol 1950;64:200–208.

    • Search Google Scholar
    • Export Citation
  • 5

    Zinman L, Dowd JB. Partial nephrectomy in renal cell carcinoma. Surg Clin North Am 1967;47:685–693.

  • 6

    Uzzo RG, Novick AC. Nephron sparing surgery for renal tumors: indications, techniques and outcomes. J Urol 2001;166:6–18.

  • 7

    Novick AC. Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med 2002;53:393-407.

  • 8

    Lee CT, Katz J, Shi W. Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 2000;163:730–736.

  • 9

    Barbalias GA, Liatsikos EN, Tsintavis A, Nikiforidis G. Adenocarcinoma of the kidney: Nephron-sparing surgical approach vs. radical nephrectomy. J Surg Oncol 1999;72:156–161.

    • Search Google Scholar
    • Export Citation
  • 10

    Belldegrun A, Tsui KH, deKernion JB, Smith RB. Efficacy of nephron-sparing surgery for renal cell carcinoma: analysis based on the new 1997 tumor-node-metastasis staging system. J Clin Oncol 1999;17:2868–2875.

    • Search Google Scholar
    • Export Citation
  • 11

    D'Armiento M, Damiano R, Feleppa B. Elective conservative surgery for renal carcinoma versus radical nephrectomy: A prospective study. Br J Urol 1997;79:15–19.

    • Search Google Scholar
    • Export Citation
  • 12

    Indudhara R, Bueschen AJ, Urban DA. Nephron-sparing surgery compared with radical nephrectomy for renal tumors: current indications and results. South Med J 1997;90:982–985.

    • Search Google Scholar
    • Export Citation
  • 13

    Lerner SE, Hawkins CA, Blute ML. Disease outcome in patients with low stage renal cell carcinoma treated with nephron sparing or radical surgery. J Urol 1996;155:1868–1873.

    • Search Google Scholar
    • Export Citation
  • 14

    Butler BP, Novick AC, Miller DP. Management of small unilateral renal cell carcinomas: Radical versus nephron-sparing surgery. Urology 1995;45:34–40; discussion 40–41.

    • Search Google Scholar
    • Export Citation
  • 15

    Leibovich BC, Blute ML, Cheville JC. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 2004;171:1066–1070.

    • Search Google Scholar
    • Export Citation
  • 16

    Corman JM, Penson DF, Hur K. Comparison of complications after radical and partial nephrectomy: Results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int 2000;86:782–789.

    • Search Google Scholar
    • Export Citation
  • 17

    Stephenson AJ, Hakimi AA, Snyder ME, Russo P. Complications of radical and partial nephrectomy in a large contemporary cohort. J Urol 2004;171:130–134.

    • Search Google Scholar
    • Export Citation
  • 18

    Lau WK, Blute ML, Weaver AL. Matched comparison of radical nephrectomy vs nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000;75:1236–1242.

    • Search Google Scholar
    • Export Citation
  • 19

    McKiernan J, Simmons R, Katz J, Russo P. Natural history of chronic renal insufficiency after partial and radical nephrectomy. Urology 2002;59:816–820.

    • Search Google Scholar
    • Export Citation
  • 20

    Clayman RU, Kavoussi LR, Soper NJ. Laparoscopic nephrectomy: Initial case report. J Urol 1991;146:278–282.

  • 21

    Dunn MD, Portis AJ, Shalhav AL. Laparoscopic versus open radical nephrectomy: A 9-year experience. J Urol 2000;164:1153–1159.

  • 22

    Abbou CC, Cicco A, Gasman D. Retroperitoneal laparoscopic versus open radical nephrectomy. J Urol 1999;161:1776–1780.

  • 23

    Gill IS, Schweizer D, Hobart MG. Retroperitoneal laparoscopic radical nephrectomy: The Cleveland clinic experience. J Urol 2000;163:1665–1670.

    • Search Google Scholar
    • Export Citation
  • 24

    Cadeddu JA, Ono Y, Clayman RV. Laparoscopic nephrectomy for renal cell cancer: Evaluation of efficacy and safety: A multicenter experience. Urology 1998;52:773–777.

    • Search Google Scholar
    • Export Citation
  • 25

    Chan DY, Cadeddu JA, Jarrett TW. Laparoscopic radical nephrectomy: Cancer control for renal cell carcinoma. J Urol 2001;166:2095–2099; discussion 2099–2100.

    • Search Google Scholar
    • Export Citation
  • 26

    Saika T, Ono Y, Hattori R. Long-term outcome of laparoscopic radical nephrectomy for pathologic T1 renal cell carcinoma. Urology 2003;62:1018–1023.

    • Search Google Scholar
    • Export Citation
  • 27

    Portis AJ, Yan Y, Landman J. Long-term followup after laparoscopic radical nephrectomy. J Urol 2002;167:1257–1262.

  • 28

    McDougall EM, Clayman RV, Anderson K. Laparoscopic wedge resection of a renal tumor: initial experience. J Laparoendosc Surg 1993;3:577–581.

  • 29

    Gill IS, Matin SF, Desai MM. Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 2003;170:64–68.

    • Search Google Scholar
    • Export Citation
  • 30

    Volpe A, Panzarella T, Rendon RA. The natural history of incidentally detected small renal masses. Cancer 2004;100:738–745.

  • 31

    Marberger M, Mauermann J. Energy Ablative Nephron-Sparing Treatment of Renal Tumors. Linthicum, MD: American Urological Association; 2004.

  • 32

    De Sio M, Autorino R, Di Lorenzo G. Adrenalectomy: defining its role in the surgical treatment of renal cell carcinoma. Urol Int 2003;7:361-367.

    • Search Google Scholar
    • Export Citation
  • 33

    Paul R, Mordhorst J, Leyh H, Hartung R. Incidence and outcome of patients with adrenal metastases of renal cell cancer. Urology 2001;57:878–882.

    • Search Google Scholar
    • Export Citation
  • 34

    Siemer S, Lehmann J, Kamradt J. Adrenal metastases in 1635 patients with renal cell carcinoma: Outcome and indication for adrenalectomy. J Urol 2004;171(6 Pt 1): 2155–2159; discussion, 2159.

    • Search Google Scholar
    • Export Citation
  • 35

    Blom JH, van Poppel H, Marechal JM. Radical nephrectomy with and without lymph node dissection: preliminary results of the EORTC randomized phase III protocol 30881. EORTC Genitourinary Group. Eur Urol 1999;36:570–575.

    • Search Google Scholar
    • Export Citation
  • 36

    Pantuck AJ, Zisman A, Dorey F. Renal cell carcinoma with retroperitoneal lymph nodes: role of lymph node dissection. J Urol 2003;169:2076–2083.

    • Search Google Scholar
    • Export Citation
  • 37

    Pantuck AJ, Zisman A, Dorey F. Renal cell carcinoma with retroperitoneal lymph nodes. Impact on survival and benefits of immunotherapy. Cancer 2003;97:2995–3002.

    • Search Google Scholar
    • Export Citation
  • 38

    Vasselli JR, Yang JC, Linehan WM. Lack of retroperitoneal lymphadenopathy predicts survival of patients with metastatic renal cell carcinoma. J Urol 2001;166:68–72.

    • Search Google Scholar
    • Export Citation
  • 39

    Janzen NK, Kim HL, Figlin RA, Belldegrun AS. Surveillance after radical or partial nephrectomy for localized renal cell carcinoma and management of recurrent disease. Urol Clin North Am 2003;30:843–852.

    • Search Google Scholar
    • Export Citation
  • 40

    Motzer RJ, Russo P. Systemic therapy for renal cell carcinoma. J Urol 2000;163:408–417.

  • 41

    Fyfe G, Fisher RI, Rosenberg SA. Results of treatment of 255 patients with metastatic renal cell carcinoma who received high-dose recombinant interleukin-2 therapy. J Clin Oncol 1995;13:688–696.

    • Search Google Scholar
    • Export Citation
  • 42

    Fisher RI, Rosenberg SA, Fyfe G. Long-term survival update for high-dose recombinant interleukin-2 in patients with renal cell carcinoma. Cancer J Sci Am 2000;6(Suppl 1):S55–S57.

    • Search Google Scholar
    • Export Citation
  • 43

    Flanigan RC, Yonover PM. The role of radical nephrectomy in metastatic renal cell carcinoma. Semin Urol Oncol 2001;19:98–102.

  • 44

    Mosharafa A, Koch M, Shalhav A. Nephrectomy for metastatic renal cell carcinoma: Indiana University experience. Urology 2003;62:636–640.

  • 45

    Tigrani VS, Reese DM, Small EJ, Presti JC Jr, Carroll PR. Potential role of nephrectomy in the treatment of metastatic renal cell carcinoma: A retrospective analysis. Urology 2000;55:36–40.

    • Search Google Scholar
    • Export Citation
  • 46

    Walther MM, Yang JC, Pass HI. Cytoreductive surgery before high dose interleukin-2 based therapy in patients with metastatic renal cell carcinoma. J Urol 1997;158:1675–1678.

    • Search Google Scholar
    • Export Citation
  • 47

    Mickisch GH, Garin A, van Poppel H. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet 2001;358:966–970.

    • Search Google Scholar
    • Export Citation
  • 48

    Flanigan RC, Salmon SE, Blumenstein BA. 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.

    • Search Google Scholar
    • Export Citation
  • 49

    O'Dea M J, Zincke H, Utz DC, Bernatz PE. The treatment of renal cell carcinoma with solitary metastasis. J Urol 1978;120:540–542.

  • 50

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

  • 51

    Kierney PC, van Heerden JA, Segura JW, Weaver 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.

    • Search Google Scholar
    • Export Citation
  • 52

    Kavolius JP, Mastorakos DP, Pavlovich C. Resection of metastatic renal cell carcinoma. J Clin Oncol 1998;16:2261–2266.

Copyright:
Copyright © 2005 by the National Comprehensive Cancer Network 2005
Page Numbers:
95–102
Article Category:
Research Article
Received:
11 Oct 2004
Accepted:
15 Nov 2004
Print Publication Date:
01 Jan 2005
Online Publication Date:
Jan 2005
Keywords:
Renal cancer; partial nephrectomy; laparoscopy; immunotherapy; adrenalectomy; metastectomy; lymphadenectomy; cytoreduction
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