This module covers the surgical treatment of renal cell carcinoma. As the only effective therapy for localized disease, surgery is a mainstay of treatment. Important points about surgical technique will be reviewed, including radical nephrectomy vs nephron-sparing surgery for localized disease, and the benefits and risks of laparoscopic vs open surgery. The appropriate selection of patients for radical vs partial nephrectomy is also addressed. Next, the module covers the safety and efficacy of new ablative techniques, for the treatment of patients who are not surgical candidates. The role of surgery in metastatic disease is also examined. Although recent studies support the addition of nephrectomy to systemic therapy, the careful selection of patients suitable for cytoreductive nephrectomy is crucial for maximizing outcomes. The role of metastasectomy is considered, as is the role of lymph node dissection in localized and metastatic disease. Finally, this module addresses the challenges of integrating surgery into the current treatment landscape, with the increasing use of targeted therapies.





MODULE I
Slide Deck 3 Objectives and Outcomes of Surgical Treatment

Christopher G. Wood, MD, FACS
Associate Professor of Urology
Department of Urology
The University of Texas M.D. Anderson Cancer Center
Houston, Texas

References
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2. Flanigan RC, Salmon SE, Blumenstein BA, et al. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. 2001;345:1655-1659.
3. Han KR, Pantuck AJ, Bui MH, et al. Number of metastatic sites rather than location dictates overall survival of patients with node-negative metastatic renal cell carcinoma. Urology. 2003;61:314-319.
4. Kavolius JP, Mastorakos DP, Pavlovich C, et al. Resection of metastatic renal cell carcinoma. J Clin Oncol. 1998;16:2261-2266.
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7. Leibovich BC, Blute ML, Cheville JC, et al. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;17:1066-1070.
8. Margulis V, Tamboli P, Jacobsohn KM, Swanson DA, Wood CG. Oncological efficacy and safety of nephron-sparing surgery for selected patients with locally advanced renal cell carcinoma. BJU Int. 2007;100:1235-1239.
9. Mickisch GH, Garin A, van Poppel H, et al. Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet. 2001;358:966-970.
10. National Comprehensive Cancer Network. "Kidney Cancer." NCCN Clinical Practice Guidelines in Oncology 2007;v.1.2008.
11. Pahernik S, Roos F, Röhrig B, Wiesner C, Thüroff JW. Elective nephron sparing surgery for renal cell carcinoma larger than 4 cm. J Urol. 2008;179:71-74.
12. Pantuck AJ, Belldegrun AS, Figlin RA. Cytoreductive nephrectomy for metastatic renal cell carcinoma: is it still imperative in the era of targeted therapy? Clin Cancer Res. 2007;13(2 Pt 2):693s-696s.
13. Patard JJ, Shvarts O, Lam JS, et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171(6 Pt 1):2181-2185.
14. Rini BI, Campbell SC. The evolving role of surgery for advanced renal cell carcinoma in the era of molecular targeted therapy. J Urol. 2007;177:1978-1984.
15. Rouviere O, Bouvier R, Negrier S, et al. Nonmetastatic renal cell carcinoma: is it really possible to define rational guidelines for post treatment follow up? Nat Clin Pract Oncol. 2006;3:200-213.
16. Thompson RH, Boorjian SA, Lohse CM, et al. Radical nephrectomy for pT1a renal masses may be associated with decreased overall survival compared with partial nephrectomy. J Urol. 2008;179:468-473.

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