Surgery in Advanced/Metastatic Renal Tumors

Renal cell cancer represents 2-3% of all cancers with the highest incidence in Western countries. Due to the Chemo-Radiation resistant nature of these tumors, nephrectomy remains as the standard of care in localized and selected advanced renal tumors. Although several studies suggest that lymph node dissection during nephrectomy does not improve cancer specific and overall survival, it may be considered in order to make a better staging and decreasing the risk of local recurrence. Extension of tumor in the venous system in the shape of a tumor thrombus is a challenging scenario to be dealt with. Studies have been shown that a higher level of thrombus was not associated with increased tumor dissemination to LNs, perinephric fat or distant metastasis, thus all patients with non-metastatic disease and venous tumour thrombus, and an acceptable performance status, should be considered for surgical intervention. In metastatic settings, patients with good performance status and potentially resectable disease may be considered for cytoreductive surgery (with or without metastasectomy) in conjunction with systemic therapy