ESOU18: The Role of Neoadjuvant and Adjuvant Therapy in Kidney Cancer

Amsterdam, The Netherlands (UroToday.com) More than 200,000 people worldwide are diagnosed with renal-cell carcinoma (RCC) each year, and almost one third of them will die from metastatic disease. Although 5-year survival rate for metastatic disease has increased, it still remains low (8-10%). Nephrectomy can be curative for the majority of patients presenting with localized disease but nearly 40% of patients initially diagnosed with stages II and III, will eventually relapse. Therefore, development of an effective adjuvant treatment for patients in high-risk for relapse following nephrectomy is mandated.

ESOU18: Cytoreductive Nephrectomy for Metastatic RCC in the Targeted Therapy Era

Amsterdam, The Netherlands (UroToday.com) Historically, when there was no known effective systemic therapy, cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma (mRCC) was usually reserved for palliation of local and systemic symptoms. With the rare exception of a few patients with solitary metastasis, in most cases, CN alone could not achieve cure, and was often associated with serious morbidity and mortality. However, with the introduction of immunotherapy, the role of CN was re-evaluated after the combined analysis of 2 randomized trials (EORTC 30947and SWOG 89492) that examined patients with mRCC who either received IFNa alone or underwent CN followed by IFNa. These trials demonstrated improvement of median overall survival (OS) in patients who underwent CN. 

ESOU18: New Diagnostic Tools for Upper Urinary Tract TCC

Amsterdam, The Netherlands (UroToday.com) The management of upper tract urinary cancer (UTUC) has dramatically changed over the last two decades, thanks to technological advances and the better understanding of its biological process. Kidney Sparing Surgery (KSS), including the endourological approach and distal ureterectomy, were traditionally reserved for patients with contraindications to radical nephro-ureterectomy (RNU), such as patients with a solitary kidney, bilateral tumors, and chronic kidney disease [1]. Recently, the European Association of Urology (EAU) Guidelines [2] on UTUC has recommended conservative management of low risk tumors, including:

ESOU18: Surveillance After Nephrectomy: On the Way Towards Evidence Based Protocols

Amsterdam, The Netherlands (UroToday.com) According to contemporary studies 20-30% of patients with localized renal cell carcinoma (RCC) who were treated with curative intent, will present with distant or local recurrences within five years. Unfortunately, recurrences are often multifocal and despite progress in systemic treatment, cure is unlikely. However, multiple retrospective studies and a systematic review suggest that for some of these patients management of the local or distant recurrence, may result in prolonged overall survival and potentially long-term disease control. Clearly, among the rationales for follow-up (FU), is the timely detection of potentially curable recurrences, and their subjection to metastasectomy, or other forms of definitive local treatment. 

ESOU18: Unclamped Partial Nephrectomy

Amsterdam, The Netherlands (UroToday.com) Partial nephrectomy (PN) is the standard of care for clinical T1a renal tumors1,2 and it has been proven to be oncologically safe for T1b neoplasms, when technically feasible3. The main goal of PN techniques is the maximal preservation of renal function (RF), which is crucial in patients with a solitary kidney or impaired preoperative RF. 

ESOU18: Clamped Partial Nephrectomy

Amsterdam, The Netherlands (UroToday.com) Dr. Chlosta gave a short overview of why it is preferable to perform clamped partial nephrectomy. Minimal invasive partial nephrectomy has emerged as a viable alternative to open partial nephrectomy while lowering patient morbidity. Segmental artery clamping and off-clamp techniques have been developed to minimize the warm ischemia time, which, if prolonged, can worsen renal parenchyma function. 

ESOU18: The Best Treatment for Renal Masses: T1b in Elderly Patients > 75, Partial Nephrectomy: No

Amsterdam, The Netherlands (UroToday.com) The repeated retrospective comparisons between radical (RN) and partial nephrectomy (PN) series for renal cell carcinoma (RCC) initially indicated the oncological safety of an organ preserving approach for smaller renal lesions up to a diameter of 4 cm (T1a). However, up to date only one prospectively randomized trial [1], that included patients with RCC up to a size of 5 cm, confirmed the comparable therapeutic efficacy of RN versus PN. The EAU guidelines recommend PN for RCCs of stage pT1b whenever it is “technically feasible”. Beyond oncological aspects, the latter recommendation emerged from the assumption that PN versus RN is more suitable to prevent metabolic disorders such as anemia, acidosis or osteoporosis and, in addition, could result in a better preservation of the post-surgical renal function. In PN, each unit eGFR loss contributes to a higher risk of cardiovascular disorders and, in addition, a 3 % decrease in overall survival. 
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