OBJECTIVE: To describe for surgeons contemplating performing cytoreductive nephrectomy (CRN) on patients after neoadjuvant sunitinib compared to a benchmark of open radical nephrectomy, describing technical difficulties, safety and feasibility. PATIENTS AND METHODS: We compared measurable surgical parameters and perioperative complications in 22 patients with metastatic renal cell carcinoma (mRCC) undergoing CRN after neoadjuvant sunitinib, with 28 patients who underwent open radical nephrectomy for non-metastatic disease (nmRCC). RESULTS: Median blood loss (320 vs. 775 ml), median operative time (128 vs. 195 min) and median length of stay (5 vs. 7 days) were greater in the mRCC group. Surgery after sunitinib was technically challenging due to fibrosis, loss of the tissue planes that usually facilitate radical nephrectomy and abnormal blood vessel formation. Side effects of sunitinib resulted in predictable complications. CONCLUSION: CRN after treatment with sunitinib is safe and feasible in our hands, although the surgery is more time-consuming and technically demanding. A multidisciplinary approach is mandatory.
OBJECTIVE: To describe for surgeons contemplating performing cytoreductive nephrectomy (CRN) on patients after neoadjuvant sunitinib compared to a benchmark of open radical nephrectomy, describing technical difficulties, safety and feasibility. PATIENTS AND METHODS: We compared measurable surgical parameters and perioperative complications in 22 patients with metastatic renal cell carcinoma (mRCC) undergoing CRN after neoadjuvant sunitinib, with 28 patients who underwent open radical nephrectomy for non-metastatic disease (nmRCC). RESULTS: Median blood loss (320 vs. 775 ml), median operative time (128 vs. 195 min) and median length of stay (5 vs. 7 days) were greater in the mRCC group. Surgery after sunitinib was technically challenging due to fibrosis, loss of the tissue planes that usually facilitate radical nephrectomy and abnormal blood vessel formation. Side effects of sunitinib resulted in predictable complications. CONCLUSION: CRN after treatment with sunitinib is safe and feasible in our hands, although the surgery is more time-consuming and technically demanding. A multidisciplinary approach is mandatory.
Authors: Axel Bex; Peter Mulders; Michael Jewett; John Wagstaff; Johannes V van Thienen; Christian U Blank; Roland van Velthoven; Maria Del Pilar Laguna; Lori Wood; Harm H E van Melick; Maureen J Aarts; J B Lattouf; Thomas Powles; Igle Jan de Jong Md PhD; Sylvie Rottey; Bertrand Tombal; Sandrine Marreaud; Sandra Collette; Laurence Collette; John Haanen Journal: JAMA Oncol Date: 2019-02-01 Impact factor: 31.777
Authors: Nirmish Singla; Roy Elias; Rashed A Ghandour; Yuval Freifeld; Isaac A Bowman; Leonid Rapoport; Mikhail Enikeev; Jay Lohrey; Solomon L Woldu; Jeffrey C Gahan; Aditya Bagrodia; James Brugarolas; Hans J Hammers; Vitaly Margulis Journal: Urol Oncol Date: 2019-09-12 Impact factor: 2.954