Studies presented at the 37th Annual European Association of Urology Congress in Amsterdam, The Netherlands, may provide insight into the surgical management of metastatic renal cell carcinoma (mRCC).
Findings from one of the studies suggest that cytoreductive partial nephrectomy (PN) may be an acceptable alternative to cytoreductive radical nephrectomy (RN) for selected patients. In another study, a team found that robotic radiosurgery, a subspecialty of stereotactic body radiotherapy, is safe and effective for lung metastases. In a third study, investigators characterized perioperative morbidities associated with surgical metastasectomy.
The cytoreductive study included 55 and 54 patients undergoing cytoreductive PN and RN, respectively. A key inclusion criterion was remaining functional renal parenchymal volume greater than 50%. That volume was 79.0% (range 67.5%-85.8%) in the PN group vs 60.5% (range 52.0%-69.0%) in the RN group.
The PN group had significantly longer 5-year survival compared with RN group (32.1 vs 15.5 months). PN vs RN was significantly associated with a 38% decreased risk for death, presenting author Iurii Vitruk, MD, of the National Cancer Institute in Kiev, Ukraine, reported.
“Kidney preservation in [the] metastatic setting can play a role in reducing potential adverse systemic therapy events and decreasing risks of concomitant pathology deterioration within selected patients,” he said. The indication for cytoreductive PN is remaining functional parenchymal volume over 65.7%, according to Dr Vitruk.
In terms of IMDC risk group classification, 85.4% of the PN group and 98.2% of the RN group had favorable- or intermediate-risk disease.
The robotic radiosurgery (RSS) study was a retrospective single-center analysis that included 50 patients with RCC-associated lung metastases. Of these, 49 patients had clear cell and 1 had papillary RCC. The patients had a median age of 64 years at the time of RSS. Of the 50 patients, 32 (64%) had oligometastatic disease at the time of RRS and 21 (42%) received systemic therapy during RRS.
The median overall survival (OS) and progression-free survival (PFS) were 35 months and 13 months, respectively, Severin Rodler, MD, of Klinikum der Universität München in Munich, Germany, reported on behalf of his team. Only 1 patient experienced local recurrence at the treated site, and this was observed 13 months after RRS. Investigators observed adverse events in 6 (11.8%) patients, and all were grade 1 or 2.
“Robotic radiosurgery is safe and effective local treatment option for patients with metastatic RCC with high local tumor control rates,” Dr Rodler said.”
The impact on OS and PFS remains unclear, he said, but it seems to be promising considering that the patients had progressive disease at the time of RRS.
The study of perioperative morbidity resulting from surgical metastasectomy examined 30-day complications after the procedure at 2 high-volume surgical centers: Mayo Clinic in Rochester, Minnesota, and University Hospitals Leuven in Leuven, Belgium. The study included 740 surgical metastasectomies in 522 patients. The 30-day rate of major complications was 8.4%, first author Eduard Roussel, MD, of University Hospitals Leuven, reported. The rate is much lower than reflected in population-based registry data, which show an incidence of high-grade postoperative morbidity as high as 25%, he said.
Multivariable analysis demonstrated that each 10-year increase in age was significantly associated with 1.5-fold increased odds of major complications, Dr Roussel reported. Patients with multiple sites of metastasis vs a single site had significant 2.4-fold increased odds for major complications. Pancreatic metastasis significantly increased the odds of major complications 5.7-fold.
“Along with increasing age and comorbidity, patients who harbor multiple sites of disease and also those who have pancreatic metastases are at the highest risk of experiencing high-grade postoperative morbidity following these procedures,” he said.
Dr Roussel also observed, “Patients who harbor pancreatic metastases are generally considered good candidates for metastasectomy from a survival point of view, but the increased risk for perioperative morbidity provides a surgical counterargument to offer metastasectomy to these patients, and especially if they are less fit.”
Vitruk I, Semko S, Voylenko O, et al. Oncological results of cytoreductive partial nephrectomy in mRCC patients. Presented at: EAU 2022, July 1-4, 2022, Amsterdam, The Netherlands. Abstract A0372.
Rodler S, Schott M, Casuscelli J, et al. Robotic radiosurgery for the treatment of lung metastases of renal cell carcinoma. Presented at: EAU 2022, July 1-4, 2022, Amsterdam, The Netherlands. Abstract A0376.
Roussel E, Lyon TD, Sharma V, et al. Perioperative morbidity of surgical metastasectomy for renal cell carcinoma: An international multicenter study. Presented at: EAU 2022, July 1-4, 2022, Amsterdam, The Netherlands. Abstract A0373.