Dr. Thiel on Resectability in mRCC

David D. Thiel, MD, chair, Department of Urology, Mayo Clinic, discusses resectability in metastatic renal cell carcinoma (mRCC).

Surgery is often used as a blanket term for cytoreductive nephrectomy and removal of metastatic lesions in RCC, says Thiel. However, these are 2 distinct procedures with different goals. In terms of cytoreductive nephrectomy, the procedure is offered to most patients who are deemed resectable and have a good ECOG performance status of 0 or 1.

Many factors go into determining whether a patient’s kidney is removable or not. To Thiel, the decision has less to do with the size of the tumor, and more to do with the amount of lymphadenopathy around the renal hilum. For example, a large amount of lymphadenopathy around the renal artery and renal vein can make surgical resection difficult as opposed to a large tumor with a renal vein thrombosis or vena cava thrombosis without a lot of lymphadenopathy and bulky metastatic disease. In the latter case, cytoreductive nephrectomy would be recommended prior to the start of systemic therapy, concludes Thiel.