BERKELEY, CA (UroToday.com) - UroToday.com- Cytoreductive nephrectomy prior to the administration of systemic therapy has been shown to provide a significant survival benefit in patients with metastatic renal cell carcinoma (RCC).

The morbidity from these surgeries can be significant, where operative complications or rapid disease progression may preclude some patients from going on to receive systemic therapy. Primary tumors in these patients tend to be bulky, with venous extension and retroperitoneal adenopathy, but there remains a subset of patients that present without a locally advanced phenotype that could be amenable to laparoscopic approaches. Here, Matin and colleagues out of M. D. Anderson Cancer Center report on their experience with laparoscopic cytoreductive nephrectomy in selected patients with metastatic RCC.

Over a 4 year period, 176 cytoreductive nephrectomies were performed, 38 of which were approached laparoscopically. Median patient age was 62 and all patients had a performance status of 1 or less. Median OR time was 188 minutes and median tumor size was 8 cm. The median blood loss was 175 ml (p=0.008) and the median length of stay was 3.8 days (p less than 0.0001), both of which were significantly less than a contemporary group done through an open approach. The major complication rate was 5.7% and the minor complication rate was 11.4%. There were no perioperative mortalities. Elective conversion to open occurred in 7.9% of patients. Of these 38 patients, 97.4% were eligible for or received systemic therapy at a median of 41 days after surgery. Median survival for the group was 18.1 months.

Laparoscopic cytoreductive nephrectomy can be performed safely in selected patients with metastatic RCC. Careful patient selection, avoiding those with bulky retroperitoneal adenopathy, tumor thrombi, or adjacent organ involvement is critical to the success of this minimally invasive approach.

Matin SF, Madsen LT, Wood CG

Urology 68(3): 528-532, 2006.

UroToday.com Renal Cancer Section

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Written by Christopher G. Wood, MD, a Contributing Editor with UroToday.

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