title: Performing cytoreductive nephrectomy following targeted sunitinib therapy for metastatic renal cell carcinoma: a surgical perspective.
abstract: OBJECTIVE
  To describe for surgeons contemplating performing cytoreductive nephrectomy (CRN) on patients after neoadjuvant sunitinib compared to a benchmark of open radical nephrectomy, describing technical difficulties, safety and feasibility.
  
  
  METHODS
  We compared measurable surgical parameters and perioperative complications in 22 patients with metastatic renal cell carcinoma (mRCC) undergoing CRN after neoadjuvant sunitinib, with 28 patients who underwent open radical nephrectomy for non-metastatic disease (nmRCC).
  
  
  RESULTS
  Median blood loss (320 vs. 775 ml), median operative time (128 vs. 195 min) and median length of stay (5 vs. 7 days) were greater in the mRCC group. Surgery after sunitinib was technically challenging due to fibrosis, loss of the tissue planes that usually facilitate radical nephrectomy and abnormal blood vessel formation. Side effects of sunitinib resulted in predictable complications.
  
  
  CONCLUSIONS
  CRN after treatment with sunitinib is safe and feasible in our hands, although the surgery is more time-consuming and technically demanding. A multidisciplinary approach is mandatory.
authors.affiliation: Whipps Cross University Hospital, London, UK. gregshaw @ doctors.org.uk
authors.forename: Greg L
authors.initials: GL
authors.lastname: Shaw
authors.forename: Mahreen
authors.initials: M
authors.lastname: Hussain
authors.forename: Rajesh
authors.initials: R
authors.lastname: Nair
authors.forename: John
authors.initials: J
authors.lastname: Bycroft
authors.forename: Luis
authors.initials: L
authors.lastname: Beltran
authors.forename: James S A
authors.initials: JS
authors.lastname: Green
authors.forename: Thomas
authors.initials: T
authors.lastname: Powles
authors.forename: John L
authors.initials: JL
authors.lastname: Peters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001706:Biopsy; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D007211:Indoles / Q000009:adverse effects / Q000627:therapeutic use*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D007902:Length of Stay; D008131:London; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011758:Pyrroles / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000077210:Sunitinib; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib