1. Cytoreductive nephrectomy: What are the current recommendations?
After publication of CARMENA and SURTIME studies that respectively assessed the role and the timing of cytoreductive nephrectomy (CRN) in metastatic renal cell carcinoma (mRCC) setting, the urological community may wonder how far these two trials impacted the daily practice. During ESOU19, Prof. Arnaud Méjean (Paris, France), principal Investigator of CARMENA, gave a current state of art and shared his views on where we stand with respect to cytoreductive nephrectomy.
In his presentation, he focused on how selecting patients for CRN. As it has been already reported, the trial showed median overall survival (OS) with sunitinib alone was non-inferior to the cytoreductive nephrectomy followed by sunitinib. Accordingly, CRN may still have a role in mRCC patients with excellent performance status, with small lung metastases or single metastasis, and in patients with local symptoms (pain, gross hematuria). In addition, CRN may allow a delayed systemic therapy, and subsequently the associated toxicity, in patients with a slow course of disease.
2. Principles of robotic partial nephrectomy for cystic renal mass
Robotic surgery is gaining more and more indications in the field of urology. Specifically, bigger and more complex tumors are now done routinely in high volume centers.
A specific session was dedicated to the surgical approach of renal cystic mass during this meeting. Dr. Rajesh Nair (London, UK) defended the robotic approach and highlighted the major principles of robotics in the case of a cystic mass. Here are his 10 top tips: