Updated European Association of Urology Guidelines for Cytoreductive Nephrectomy in Patients with Synchronous Metastatic Clear-cell Renal Cell Carcinoma

Cytoreductive nephrectomy (CN) has been the standard of care in patients with metastatic clear-cell renal cancer who present with the tumour in place. The CARMENA trial compared systemic therapy alone with CN followed by systemic therapy. This article outlines the new guidelines based on these data.

The CARMENA trial demonstrates that immediate cytoreductive nephrectomy should no longer be considered the standard of care in patients diagnosed with intermediate and poor risk metastatic renal cell carcinoma when medical treatment is required. However, the psychological burden poor risk patients experience hearing that removal of their primary tumour will not be beneficial, should be carefully considered.

European urology. 2018 Aug 31 [Epub ahead of print]

Axel Bex, Laurence Albiges, Börje Ljungberg, Karim Bensalah, Saeed Dabestani, Rachel H Giles, Fabian Hofmann, Milan Hora, Markus A Kuczyk, Thomas B Lam, Lorenzo Marconi, Axel S Merseburger, Sergio Fernández-Pello, Rana Tahbaz, Yasmin Abu-Ghanem, Michael Staehler, Alessandro Volpe, Thomas Powles

Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. Electronic address: ., Department of Cancer Medicine, Gustave Roussy, Université Paris-Saclay, Villejuif, France., Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden., Department of Urology, University of Rennes, Rennes, France., Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Malmö, Sweden., Patient Advocate, International Kidney Cancer Coalition (IKCC), Duivendrecht, The Netherlands; Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Centre Utrecht, Utrecht, The Netherlands., Department of Urology, Sunderby Hospital, Sunderby, Sweden., Department of Urology, Faculty Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, Prague, Czech Republic., Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany., Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK; Academic Urology Unit, University of Aberdeen, Aberdeen, UK., Department of Urology, Coimbra University Hospital, Coimbra, Portugal., Department of Urology, University Hospital Schleswig-Holstein, Lübeck, Germany., Department of Urology, Cabueñes Hospital, Gijón, Spain., Department of Urology, Elbe Kliniken Stade, Stade, Germany., Department of Urology, Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel., Department of Urology, Ludwig-Maximilians University, Munich, Germany., Division of Urology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy., The Royal Free NHS Trust and Barts Cancer Institute, Queen Mary University of London, London, UK.