Locally advanced renal cell carcinoma.

Despite the observed stage migration and earlier detection of renal masses, patients still present with locally advanced renal cell carcinoma. These patients represent a difficult oncologic challenge. Despite our ability to do surgical resection to cure the disease, survival often remains limited. In this paper, we describe the role and indication for surgical resection for patients with enlarged retroperitoneal lymph nodes, invasion of adjacent organs, invasion into the vena cava or locally recurrent disease. The development of new strategies, including effective drugs to be used in association with surgical resection, will clearly be an essential step to further improve the outcome of these patients.