Renal Cell Carcinoma: Treatment Localized Tumors The standard management for stage I or II tumors and selected cases of stage III disease is radical nephrectomy. This procedure involves en bloc removal of Gerota's fascia and its contents, including the kidney, the ipsilateral adrenal gland, and adjacent hilar lymph nodes. The role of a regional lymphadenectomy is controversial. Extension into the renal vein or inferior vena cava (stage III disease) does not preclude resection even if cardiopulmonary bypass is required. If the tumor is resected, half of these patients have prolonged survival. Nephron-sparing approaches via open or laparoscopic surgery may be appropriate. | Chapter 090. Bladder and Renal Cell Carcinomas Part 7 Renal Cell Carcinoma Treatment Localized Tumors The standard management for stage I or II tumors and selected cases of stage III disease is radical nephrectomy. This procedure involves en bloc removal of Gerota s fascia and its contents including the kidney the ipsilateral adrenal gland and adjacent hilar lymph nodes. The role of a regional lymphadenectomy is controversial. Extension into the renal vein or inferior vena cava stage III disease does not preclude resection even if cardiopulmonary bypass is required. If the tumor is resected half of these patients have prolonged survival. Nephron-sparing approaches via open or laparoscopic surgery may be appropriate for patients who have only one kidney depending on the size and location of the lesion. A nephron-sparing approach can also be used for patients with bilateral tumors accompanied by a radical nephrectomy on the opposite side. Partial nephrectomy techniques are being applied electively to resect small masses for patients with a normal contralateral kidney. Adjuvant therapy following this surgery does not improve outcome even in cases with a poor prognosis. Advanced Disease Surgery has a limited role for patients with metastatic disease. However long-term survival may occur in patients who relapse after nephrectomy in a solitary site that can be removed. One indication for nephrectomy with metastases at initial presentation is to alleviate pain or hemorrhage of a primary tumor. Also a cytoreductive nephrectomy before systemic treatment improves survival for carefully selected patients with stage IV tumors. Metastatic renal cell carcinoma is highly refractory to chemotherapy and only infrequently responsive to cytokine therapy with IL-2 or IFN-a. IFN-a and IL-2 produce regressions in 10-20 of patients but on occasion these responses are durable. IL-2 was approved on the observation of durable complete remission in a small proportion of cases. The situation
