"Surgical Innovations in the Treatment of Renal Cell Carcinoma"
Christopher Wood, MD

Speaker

Dr. Christopher Wood, MD is Associate Professor of Urology and Cancer Biology at the U. of Texas MD Anderson Cancer Center. He is currently funded by the CaPCure organization to study gene therapy targets for angiogenesis in prostate cancer. He has a strong interest in developing chemoprevention strategies for cancer in general, but urologic malignancies in particular

Talk

[Note: Below I have reproduced the handout provided by Dr. Wood, with my comments in brackets. Dr. Wood gave an amusing, "simplified" view of surgical treatment options for cancer as, "freeze it, cook it, or cut it out".]

Introduction: In the past, the surgical management of renal cell carcinoma has been limited to performing radical nephrectomy in the presence of clinically localized or locally advanced disease, resection of local recurrences, and rarely, metastatectomy in patients with surgically resectable metastasis. As we have gained further understanding of the biology of renal cell carcinoma, urologic oncologists have endeavored to both expand and refine surgical therapy in the treatment of renal cell carcinoma. New frontiers have been aimed at the development and critical evaluation of nephron sparing surgery and minimally invasive surgery as new elements in the urologic oncologist's surgical armamentarium. In addition, new tumor ablative modalities are being tested in patients with localized disease as alternatives to traditional extirpative surgery. Finally, a new paradigm that includes an expanded role for surgical therapy in aggressive and metastatic disease is being developed. This presentation will discuss the current role and future aims of surgical intervention in the management of renal cell carcinoma.

  1. Nephron sparing surgery in the management of renal cell carcinoma.
    1. Nephron sparing surgery in patients with a solitary kidney. [This has been the norm for some time to avoid dialysis.]
    2. Nephron sparing surgery in patients with a normal contralateral kidney. [This is gaining acceptance to retain as much kidney as possible in case of future additional loss of kidney function.]
    3. Tumor multifocality and recurrence rates following nephron sparing surgery. [Mutifocality means more than one tumor, and a consistent percentage of RCC has multifocality. I did not write down any figures, but recurrence for nephron sparing surgery was said to approach radical nephrectomy.]
  2. Minimally invasive surgery in the management of renal cell carcinoma.
    1. Hand assisted laparoscopic nephrectomy in the management of renal cell carcinoma. [Some don't call this "pure" laparoscopic. Dr. Wood indicated he felt that if you have to make an incision large enough to get the kidney out anyway, you might as well use the hand-assisted technique.]
    2. Trans-abdominal and retroperitoneal laparoscopic surgery. [These are different locations on the body where the surgery is centered to get at the kidney.]
    3. Morcellation vs. intact extraction [Dr. Wood is anti-morcellation because of risk of having cancerous cells escape. He referenced a study where the morcellation bags were tested after the surgery and many of them leaked if filled with water.]
    4. Controversy: Nephron sparing surgery vs. minimally invasive surgery in the management of small renal masses: Can we have the best of both worlds?? [This refers to laparoscopic partial nephrectomy. Dr. Wood indicated this does not necessarily offer the patient an advantage as the surgery is very lengthy this way. "Not ready for prime time"]
  3. New techniques of primary tumor ablation in the management of renal cell carcinoma.
    1. Cryoablation
    2. Radio Frequency Ablation [I believe he indicated he favored open surgery to help visualize the tumor and the treatment area for both RFA and cryo, however my notes are sketchy on this. He didn't feel either of these was ready to become the primary treatment choice.]
    3. Gene therapy
  4. Development of adjuvant therapy in the management of metastatic renal cell carcinoma
  5. Role of surgical therapy in the management of metastatic renal cell carcinoma
    1. Cytoreductive nephrectomy in patients with metastatic renal cell carcinoma
      1. Rationale and supporting data
      2. Predictors and prognosis
      3. Outcomes
      4. Relative contraindications
    2. Palliative nephrectomy in patients with metastatic disease
    3. Surgical consolidation after response to systemic therapy. Is metastatic renal cell carcinoma a surgical disease?


This Kidney Cancer FAQ Page By PJ Boyle. Copyright 2001 PJ Boyle
Last Updated August 3, 2001