Thomas Anil A, Rini Brian I, Stephenson Andrew J, Garcia Jorge A, Fergany Amr, Krishnamurthi Venkatesh, Novick Andrew C, Gill Inderbir S, Klein Eric A, Zhou Ming, Campbell Steven C
Glickman Urological and Kidney Institute, Cleveland, Ohio 44195, USA.
J Urol. 2009 Sep;182(3):881-6. doi: 10.1016/j.juro.2009.05.014. Epub 2009 Jul 17.
The development of targeted agents for renal cell carcinoma has renewed interest in consolidative surgery due to the robust clinical responses seen with these agents. The integration of targeted therapy and surgery requires careful consideration due to the potential for increased perioperative morbidity.
We retrospectively identified patients with renal cell carcinoma treated with sunitinib, sorafenib or bevacizumab plus interleukin-2 before tumor resection.
Between June 2005 and August 2008, 19 patients were treated with targeted therapy and subsequently underwent resection. Surgical extirpation involved an open and a laparoscopic approach in 18 and 3 cases, respectively, for locally advanced (8), locally recurrent (6) and metastatic disease (3). Two patients with extensive bilateral renal cell carcinoma were also treated to downsize the tumors to enable partial nephrectomy. Perioperative complications were noted in 16% of patients. One patient had a significant intraoperative hemorrhage and disseminated intravascular coagulopathy from a concomitant liver resection. An anastomotic bowel leak and abscess were noted postoperatively in another patient who underwent en bloc resection of a retroperitoneal recurrence and adjacent colon. Two patients (11%) had minor wound complications, including a wound seroma and a ventral hernia. Pathological analysis of 20 specimens revealed clear cell, chromophobe and unclassified renal cell carcinoma in 80%, 5% and 10% of cases, respectively. One patient (5%) had a pathological complete response.
Surgical resection of renal cell carcinoma after targeted therapy is feasible with low morbidity in most patients. However, significant complications can occur, raising concern for possible compromise of tissue and/or vascular integrity associated with surgery in this setting.
由于在肾细胞癌中使用靶向药物后出现了显著的临床反应，因此对巩固性手术的兴趣再次兴起。由于围手术期发病率可能增加，靶向治疗与手术的结合需要仔细考虑。
我们回顾性地确定了在肿瘤切除术前接受舒尼替尼、索拉非尼或贝伐单抗加白细胞介素-2治疗的肾细胞癌患者。
2005年6月至2008年8月期间，19例患者接受了靶向治疗，随后接受了手术切除。手术切除包括18例开放手术和3例腹腔镜手术，用于局部晚期（8例）、局部复发（6例）和转移性疾病（3例）。两名双侧广泛性肾细胞癌患者也接受了治疗，以缩小肿瘤大小以便进行部分肾切除术。16%的患者出现围手术期并发症。一名患者在同时进行肝切除时发生了严重的术中出血和弥散性血管内凝血。另一名接受腹膜后复发和相邻结肠整块切除的患者术后出现吻合口肠漏和脓肿。两名患者（11%）出现轻微伤口并发症，包括伤口血清肿和腹疝。对20个标本的病理分析显示，透明细胞癌、嫌色细胞癌和未分类肾细胞癌分别占病例的80%、5%和10%。一名患者（5%）出现病理完全缓解。
大多数患者在接受靶向治疗后进行肾细胞癌手术切除是可行的，发病率较低。然而，可能会发生严重并发症，这引发了对这种情况下与手术相关的组织和/或血管完整性可能受到损害的担忧。
