title: Surgery of locally advanced and metastatic kidney cancer after tyrosine kinase inhibitors therapy: single institute experience.
abstract: Renal cell carcinoma (RCC) is the most common tumor of the kidney. Considering the TNM classification of 2009, locally advanced and metastatic diseases are included in the groups stage III and IV. The surgical treatment of these tumors could be divided into 3 categories: (1) curative (nephrectomy and/or metastasectomy), (2) cytoreductive, and (3) palliative. Targeted agents showed impressive antitumor efficacy and prolongation of progression-free survival. The integration between target therapy and surgery in patients with locally advanced or metastatic RCC has sometimes facilitated surgery. We aimed to evaluate patients' response to tyrosine kinase inhibitor (TKI) therapy and the feasibility of surgery after that and to observe complications related to surgery.
  From February 2007 to September 2014 in the Istituto Tumori of Milan, IRCCS, we selected patients with locally advanced or metastatic diseases, treated with target therapy before surgery (which comprised nephrectomy or partial nephrectomy, cytoreductive surgery, and metastasectomy) and cryoablation.
  We selected 33 patients who underwent surgery after TKI therapy. As for response to TKIs, 20 patients (60%) had stable disease, 9 patients (28%) had a partial response, and 4 patients (12%) had progressive disease. A total of 17 patients (51%) presented complications directly or indirectly related to surgery and most of those were classified as grade II Clavien-Dindo score.
  The association between TKI and surgery seems to have no contraindications. Our dataset provides an example of how surgery after TKI is possible in locally advanced metastatic tumor and does not have an excessive rate of postoperative complications.
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.|Current affiliation: Department of Urology, Treviso Hospital, Ulss 2 Marca Trevigiana, Treviso - Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: De Gobbi
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Biasoni
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Catanzaro
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Nicolai
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Piva
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stagni
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Tullio
authors.initials: T
authors.lastname: Torelli
authors.affiliation: 2 Department of Oncology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Procopio
authors.affiliation: 2 Department of Oncology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Verzoni
authors.affiliation: 2 Department of Oncology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Grassi
authors.affiliation: 3 Department of Pathology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Colecchia
authors.affiliation: 3 Department of Pathology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Biagio
authors.initials: B
authors.lastname: Paolini
authors.affiliation: 4 Department of Radiology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Spreafico
authors.affiliation: 4 Department of Radiology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Marchianò
authors.affiliation: 1 Department of Urology, Fondazione IRCCS Istituto dei Tumori, Milan - Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvioni
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D008297:Male; D059146:Metastasectomy / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*
chemical_list: D047428:Protein Kinase Inhibitors
keywords: Locally advanced and metastatic kidney cancer; Renal cell carcinoma; Surgery of RCC; Tyrosine kinase inhibitor