title: Surgical intervention in patients with metastatic renal cancer: metastasectomy and cytoreductive nephrectomy.
abstract: For patients with metastatic renal cancer, prognostic factors defined in systemic therapy clinical trials stratify patients into good, intermediate, and poor risk groups with median survival varying from 4 to 13 months. These same factors also stratify patients whose renal cancers were initially resected completely and who then developed subsequent metastatic disease. Metastasectomy performed in low-risk patients was significantly associated with enhanced survival when compared with low-risk patients not undergoing metastasectomy. Two randomized, prospective clinical trials demonstrated a modest survival advantage of approximately 6 months for patients undergoing cytoreductive nephrectomy followed by interferon alfa-2b. Once effective systemic agents are developed, both metastasectomy and cytoreductive nephrectomy will play greater roles in consolidating clinical responses.
authors.affiliation: Department of Surgery, Urology Service, Weill Cornell College of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, N Y 10021, USA. russop@mskcc.org
authors.forename: Paul
authors.initials: P
authors.lastname: Russo
authors.forename: Matthew Francis
authors.initials: MF
authors.lastname: O'Brien
mesh_terms: D002292:Carcinoma, Renal Cell / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D020360:Neoadjuvant Therapy / Q000401:mortality; D009362:Neoplasm Metastasis / Q000517:prevention & control*; D009392:Nephrectomy / Q000379:methods* / Q000401:mortality; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors