ABSTRACT

The primary aim of this article is to discuss the role of surgery such as cytoreductive nephrectomy and/or metastasectomy in the management of metastatic renal cell carcinoma.

Up to 30% of patients with kidney cancer have metastatic disease and 30% of those treated for locally or locally advanced disease will progress to metastases. Cytotoxic chemotherapy and hormonal therapies or in combinations are ineffective in treating patients with metastatic renal cell carcinoma. A multimodal approach consisting of cytoreductive nephrectomy, metastasectomy and systemic therapy including cytokines and targeted molecules have improved the overall progression-free survival and quality of life in a selected group of patients with metastatic renal cell carcinoma.

Surgical intervention in the patients with metastatic renal cancer can ocur two settings:1. to render a paitent clinically free of all sites of primary disease and metastases, defined nephrectomy/ metastasectomy, or 2. to resect the primary tumor in the face of unresectable metastatic disease prior to the iniation of systemic therapy, termed cytoreductive nephrectomy.

Patient selection factors including performance status, low haemoglobin, high lactate dehydrogenase, high corrected serum calcium are associated with survival time in both medically and surgically treated patients with metastatic renal cancer.