[When is cytoreductive nephrectomy not beneficial for patients with metastatic renal cell carcinoma?]
Primary tumor resection in patients with synchronous metastatic renal cell carcinoma and a good performance status corresponds to a guideline recommendation which, however, is based on weak data from the era of cytokine therapy. This article presents arguments that weigh heavily against cytoreductive nephrectomy. From a molecular genetic viewpoint, the intervention eliminates only the easiest adversary but cannot prevent cancer-related death. Therefore, benefits and risks must be carefully and critically considered. Cytoreductive nephrectomy is not beneficial if treatment-induced morbidity will substantially affect the patient's quality of life and/or life expectancy or if the size and topography of the primary tumor renders it less dangerous than the metastases.
Klinik für Urologie und Kinderurologie, Universitätsklinikum Magdeburg A.ö.R., Leipziger Str. 44, 39120, Magdeburg, Deutschland. martin.schostak@med.ovgu.de.
Martin
M
Schostak
D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D000066491:Clinical Decision-Making / Q000379:methods; D065426:Cytoreduction Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000517:prevention & control; D009392:Nephrectomy / Q000401:mortality / Q000706:statistics & numerical data*; D015995:Prevalence; D015996:Survival Rate; D016896:Treatment Outcome
Cytokine therapy; Cytoreductive nephrectomy; Heterogenity, intratumor; Life quality; Metastasis