Renal Cell Carcinoma and the General Medical Oncologist: Where We Are and Where We’re HeadedCytoreductive nephrectomy for primary RCC with metastases
1:29 minutes.
TRANSCRIPTION:
DR STADLER: Those patients that are symptomatic we tend to treat with systemic therapy first. Many of these patients will do poorly, and we hate to subject them to a major surgery. The other situation where this comes up is in patients with very locally advanced disease, those that have extensive metastatic disease and a possible invasion into the liver, extensive retroperitoneal lymphadenopathy. DR LOVE: Bob? DR MOTZER: I’m a proponent for cytoreductive nephrectomy, but I think it’s important to select the proper patient. And one of the situations that we want to avoid, particularly now that there’s effective systemic therapy, is a patient undergoing a cytoreductive nephrectomy and then having a complication so that he can never go on to get the effective systemic therapy. We found that patients with a low performance status were the ones that were most likely to suffer a complication in the perioperative period. DR LOVE: Dave? DR McDERMOTT: I think it’s important to remember that while we think cytoreductive nephrectomy adds a survival advantage for the typical patient, that advantage is relatively small. That advantage was obtained in an era when we didn’t have active drugs. Now that we do, it may not be as large or it may not exist altogether. |