Cytoreductive Nephrectomy - Changing Times?
BAUS ePoster online library. Tait C. Jun 25, 2019; 259584; P8-8
Mr. Campbell Tait
Mr. Campbell Tait
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Abstract
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Introduction

The recent CARMENA study has questioned the role of cytoreductive nephrectomy. We have reviewed our practice over the past 5 years with a view to selection and outcomes.

Patients and Methods

We reviewed patients who underwent cytoreductive nephrectomy for metastatic renal cancer, over a 5 year period. We assessed outcomes including complications, overall survival, disease progression and pre/post-operative use of systemic therapies such as tyrosine kinase inhibitors (TKIs).

RESULTS

43 cytoreductive nephrectomy patients were identified between February 2012 and December 2017 (36 males, 7 females) with a mean age of 61 (33-79). 38/43 patients had conventional clear cell renal carcinoma. 22/43 (Group A) patients underwent upfront cytoreductive nephrectomy and were treated with TKI therapy post surgery. 36.4% (8) of these patients are still alive (42.6 months average follow up). 11 patients (Group B) commenced TKI therapy pre-operatively and underwent subsequent cytoreductive nephrectomy according to response. 27.3% (3) of these patients are still alive (56.3 months average follow up). 10 patients underwent cytoreductive nephrectomy and had no further treatment. 60% (6) of these patients are still alive.

Conclusions

There is a trend towards TKI therapy prior to surgery in patients with a large metastatic burden. This does not appear to affect surgical morbidity, although we found a higher rate of blood transfusion in the group who had undergone pre-operative TKI therapy. Patients with large primary tumours and low metastatic burden have been managed by upfront nephrectomy without pre-operative TKIs. It will be interesting to see how CARMENA alters UK practice.
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