Idir Ouzaid1, Umberto Capitanio2, Michael Staehler3, Christopher G Wood4, Bradley C Leibovich5, Börje Ljungberg6, Hendrik Van Poppel7, Karim Bensalah8. 1. Department of Urology, Hôpital Bichat Claude Bernard, Paris Diderot University, Paris, France. 2. Department of Urology, San Raffaele Scientific Institute and Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy. 3. Department of Urology, Ludwig-Maximilians University, Munich, Germany. 4. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Urology, Mayo Clinic, Rochester, MN, USA. 6. Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden. 7. Department of Urology, University Hospitals of KU Leuven, Leuven, Belgium. 8. Department of Urology, University of Rennes, Rennes, France.
Abstract
CONTEXT: The benefit of surgical metastasectomy (SM) for patients with metastatic renal cell carcinoma (mRCC) remains controversial because of the lack of high-level evidence on the role of SM in terms of survival benefit in the era of systemic therapy. OBJECTIVE: To perform a systematic review of the literature on the role of SM in the treatment of mRCC and discuss key issues in the SM decision-making process. EVIDENCE ACQUISITION: A systematic search of the Embase and Medline databases was carried out and a systematic review of the role of SM in mRCC was performed. A total of 56 studies were finally included in the evidence synthesis. EVIDENCE SYNTHESIS: All the studies included were retrospective and mostly noncomparative. Median overall survival (OS) ranged from 36 to 142mo for those undergoing SM, compared to 8-27mo for no SM. SM was associated with a lower risk of all-cause mortality compared to no SM (pooled adjusted hazard ratio 2.37, 95% confidence interval 2.03-2.87; p<0.001). Morbidity and mortality were similar for SM and primary tumor surgery. The most important prognostic factor for OS was complete resection of metastases. Other prognostic factors included disease free-survival from nephrectomy, primary tumor features (T stage ≥3, high grade, sarcomatoid features, and pathological nodal status), the number of metastases, and performance status. Lung metastasectomy seemed to show the best survival benefit. CONCLUSIONS: Although no randomized clinical data are available, published studies support the role of SM in selected patients in the modern era. Complete SM allows sustained survival free of systemic treatment. Integration of SM and systemic therapy in a multimodal approach remains a valid option for some patients. PATIENT SUMMARY: Surgical resection of metastases originating from renal cell carcinoma may play a role in prolonging survival and avoiding systemic therapy when complete resection is achievable. This strategy is an option for selected patients with a limited number of metastases who still have good general health status.
CONTEXT: The benefit of surgical metastasectomy (SM) for patients with metastatic renal cell carcinoma (mRCC) remains controversial because of the lack of high-level evidence on the role of SM in terms of survival benefit in the era of systemic therapy. OBJECTIVE: To perform a systematic review of the literature on the role of SM in the treatment of mRCC and discuss key issues in the SM decision-making process. EVIDENCE ACQUISITION: A systematic search of the Embase and Medline databases was carried out and a systematic review of the role of SM in mRCC was performed. A total of 56 studies were finally included in the evidence synthesis. EVIDENCE SYNTHESIS: All the studies included were retrospective and mostly noncomparative. Median overall survival (OS) ranged from 36 to 142mo for those undergoing SM, compared to 8-27mo for no SM. SM was associated with a lower risk of all-cause mortality compared to no SM (pooled adjusted hazard ratio 2.37, 95% confidence interval 2.03-2.87; p<0.001). Morbidity and mortality were similar for SM and primary tumor surgery. The most important prognostic factor for OS was complete resection of metastases. Other prognostic factors included disease free-survival from nephrectomy, primary tumor features (T stage ≥3, high grade, sarcomatoid features, and pathological nodal status), the number of metastases, and performance status. Lung metastasectomy seemed to show the best survival benefit. CONCLUSIONS: Although no randomized clinical data are available, published studies support the role of SM in selected patients in the modern era. Complete SM allows sustained survival free of systemic treatment. Integration of SM and systemic therapy in a multimodal approach remains a valid option for some patients. PATIENT SUMMARY: Surgical resection of metastases originating from renal cell carcinoma may play a role in prolonging survival and avoiding systemic therapy when complete resection is achievable. This strategy is an option for selected patients with a limited number of metastases who still have good general health status.
Authors: Giuseppe Rosiello; Sophie Knipper; Carlotta Palumbo; Cristina Dzyuba-Negrean; Angela Pecoraro; Elio Mazzone; Francesco A Mistretta; Zhe Tian; Umberto Capitanio; Francesco Montorsi; Shahrokh F Shariat; Fred Saad; Alberto Briganti; Pierre I Karakiewicz Journal: Int Urol Nephrol Date: 2019-08-29 Impact factor: 2.370
Authors: Antonino Battaglia; Gaëtan Devos; Karel Decaestecker; Manuel Witters; Lisa Moris; Thomas Van den Broeck; Charlien Berghen; Wouter Everaerts; Maarten Albersen; Arman Tsaturyan; Gert De Meerleer; Hein Van Poppel; Karolien Goffin; Piet Ost; Lorenzo Tosco; Steven Joniau Journal: World J Urol Date: 2019-03-12 Impact factor: 4.226
Authors: Oliver Beetz; Rabea Söffker; Sebastian Cammann; Felix Oldhafer; Florian W R Vondran; Florian Imkamp; Jürgen Klempnauer; Moritz Kleine Journal: Langenbecks Arch Surg Date: 2020-01-14 Impact factor: 3.445
Authors: Andrey Soares; Fernando Sabino Marques Monteiro; Fernando Cotait Maluf; Diogo Assed Bastos; Denis Leonardo Jardim; André Deeke Sasse; Adriano Gonçalves E Silva; André P Fay; Diogo Augusto Rodrigues da Rosa; Evanius Wierman; Fabio Kater; Fabio A Schutz; Fernando Nunes Galvão de Oliveira; Igor Alexandre Protzner Morbeck; José Augusto Rinck; Karine Martins da Trindade; Manuel Caitano Maia; Vinicius Carrera Souza; Deusdedit Cortez Vieira da Silva Neto; Felipe de Almeida E Paula; Fernando Korkes; Gustavo Franco Carvalhal; Lucas Nogueira; Roni de Carvalho Fernandes; Rodolfo Borges Dos Reis; Wagner Eduardo Matheus; Wilson Francisco Schreiner Busato; Walter Henriques da Costa; Stênio de Cássio Zequi Journal: J Cancer Res Clin Oncol Date: 2020-05-14 Impact factor: 4.553