Victor Espinheira Santos, Rafael Ribeiro Meduna, Wilson Bachega Jr., Gustavo Cardoso Guimarães
Serviço de Urologia, Departamento de Cirurgia Pélvica, AC Camargo Cancer Center, São Paulo, SP, Brasil
License: CC-BY – All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License
Official Impact Factor = 0.976
5-Year Impact Factor = 1.097
ISSN Eletronic Version: 1677-6119
Printed Version: 1677-5538
El cáncer de riñón esta entre los 10 canceres mas comunes, tanto en hombres como en mujeres. Este tipo de patología se produce en los riñones, dos órganos que tienen la función de filtrar la sangre, y eliminar desechos y el exceso de líquidos del organismo.
O presente video mostra uma nova técnica de sutura laparoscópica do rim após retirada de um tumor para reduzir o tempo em que o rim fica clampeado e consequentemente sem perfusão. Esta técnica tem o potencial de manter uma melhor função do rim e reduzir a morbidade cirúrgica através da laparoscopia. Maiores informações contatar Dr Marcos Tobias Machado(tobias-machado@uol.com.br).
A nefrectomia radical é o tratamento padrão para os tumores de rim onde a nefrectomia parcial não está indicada, normalmente tumores maiores do que 6 cm. O presente video demostra 2 diferentes acessos para realização da nefrectomia radical laparoscópica. Desta forma, uma mais rápida recuperação pós-operatorio podera ser atingida, sem comprometer a cura do câncer. Maiores informações contatar Dr Marcos Tobias Machado(tobias-machado@uol.com.br)
Metastatic renal-cell carcinoma has diverse clinical presentations ranging from incidental detection to a highly symptomatic systemic illness. Patients with metastatic renal-cell carcinoma are assigned a risk category — favorable, intermediate, or poor — on the basis of two published models containing five or six pretreatment selection factors, including presence of anemia, elevated serum calcium concentration, and degree of disability from cancer-related symptoms (performance status). This stratification provides important prognostic insight about whether patients should be treated with cytoreductive radical nephrectomy, systemic therapies, or both. Nephrectomy for stage IV disease removes the primary kidney tumor and its potential for bleeding and…
Cytoreductive nephrectomy, a standard approach for de novo metastatic renal cell carcinoma in the era of cytokine therapy, has been upheld during the age of targeted therapy on the basis of retrospective data. Now, the first level I prospective data from the CARMENA and SURTIME trials challenge this standard.
In clinical practice, patients with primary metastatic renal cell carcinoma (mRCC) have been offered cytoreductive nephrectomy (CN) followed by targeted therapy, but the optimal sequence of surgery and systemic therapy is unknown.
To examine whether a period of sunitinib therapy before CN improves outcome compared with immediate CN followed by sunitinib.
This randomized clinical trial began as a phase 3 trial on July 14, 2010, and continued until March 24, 2016, with a median follow-up of 3.3 years and a clinical cutoff date for this report of May 5, 2017. Patients with mRCC of clear cell subtype, resectable primary tumor, and 3 or fewer surgical risk factors were studied.
Immediate CN followed by sunitinib therapy vs treatment with 3 cycles of sunitinib followed by CN in the absence of progression followed by sunitinib therapy.
Progression-free survival was the primary end point, which needed a sample size of 458 patients. Because of poor accrual, the independent data monitoring committee endorsed reporting the intention-to-treat 28-week progression-free rate (PFR) instead. Overall survival (OS), adverse events, and postoperative progression were secondary end points.
The study closed after 5.7 years with 99 patients (80 men and 19 women; mean [SD] age, 60 [8.5] years). The 28-week PFR was 42% in the immediate CN arm (n = 50) and 43% in the deferred CN arm (n = 49) (P = .61). The intention-to-treat OS hazard ratio of deferred vs immediate CN was 0.57 (95% CI, 0.34-0.95; P = .03), with a median OS of 32.4 months (95% CI, 14.5-65.3 months) in the deferred CN arm and 15.0 months (95% CI, 9.3-29.5 months) in the immediate CN arm. In the deferred CN arm, 48 of 49 patients (98%; 95% CI, 89%-100%) received sunitinib vs 40 of 50 (80%; 95% CI, 67%-89%) in the immediate arm. Systemic progression before planned CN in the deferred CN arm resulted in a per-protocol recommendation against nephrectomy in 14 patients (29%; 95% CI, 18%-43%).
Deferred CN did not improve the 28-week PFR. With the deferred approach, more patients received sunitinib and OS results were higher. Pretreatment with sunitinib may identify patients with inherent resistance to systemic therapy before planned CN. This evidence complements recent data from randomized clinical trials to inform treatment decisions in patients with primary clear cell mRCC requiring sunitinib.
