|
The incidence of renal cell carcinoma(RCC) is continuously increasing in Korea. One third of RCC patients present with metastatic disease and 20- 40% undergoing nephrectomy for clinically localized RCC will develop metastases. Eventually, 30-50% of patients develop metastatic disease. The prognosis of metastatic renal cancer is very poor with a median survival time of only 6-12 months and a 2-year survival rate of 10 to 20%. Because RCC is notoriously chemorefractory, the management of metastatic RCC has historically been mainly surgical. In some patients, surgery is indicated for symptom palliation at the primary or secondary sites. Recent advances in contemporary approach with systemic immunotherapy for this problem have rekindled interest in surgical treatment of metastatic RCC. Two recent randomized controlled trials suggest a survial advantage for cytoreductive nephrectomy. Cytoreductive surgery prior to systemic immunotherapy appears to confer a survival advantage, but this treatment regimen is suitable for the only selected patients because it can be associated with morbidity and delay in administration of systemic treatment. Therefore, patient selection, taking into the clinical predictive factors including performance status and sites and burden of disease, is most important in treatment of this group of patients. Other less invasive therapies may be equally effective, and should be considered carefully. Systemic immunotherapy followed by assessment for surgical consolidation is an alternative treatment strategy which has not yet been evaluated as in randomized trials. Patients with limited and resectable metastases should be considered for combined nephrectomy and metastasectomy and also treated with adjuvant immunotherapy. The complete surgical removal of metastatic lesions is feasible and may prolong the survival. (Korean J Urol 2005;46: 1235-1245)
|