Surgery for Metastases of Renal Cell Carcinoma
Surgery for Metastases of Renal Cell Carcinoma
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肾细胞癌转移手术
DOI：
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发表时间：
2004
影响因子：
2.4
通讯作者：
D. Swanson
中科院分区：
文献类型：
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作者：
D. Swanson
在出现有效的系统治疗（通常是免疫治疗）的时代，手术对RCC的作用尚未确定，除了孤立转移。对全身治疗后接受积极手术治疗的患者的回顾性分析强调了寻找更好的治疗方式以实现转移性疾病的完全根除的必要性。但与此同时，我们提出了这些准则。首先，我们鼓励积极的手术切除临床上孤立的转移瘤，无论是同步的还是异时的。继续无限期地随访这些患者，因为复发的可能性很大，但除非按照方案，否则不要给予辅助全身治疗。其次，仅在一个器官中的有限转移可能表现为与孤立转移类似，并且如果转移位于适合手术切除的部位，例如，肺，初次手术可能是合理的强烈建议对这些患者进行系统治疗，不一定要等到复发。第三，对于多发性转移的患者，初步的全身治疗，然后切除任何残留的疾病在选定的患者似乎是支持的经验，在几个医疗中心。尽管在绝大多数标本中发现了存活的癌症，但在高度选择的患者中，经过系统治疗后，手术后观察到明显延长的生存时间。然而，我们必须注意到试图消除所有已知疾病的发病率，并试图权衡这与潜在的利益。只有一个前瞻性的随机试验可以证实转移性肾细胞癌的积极手术方法的价值。然而，与此同时，输精管切除术至少提供了一个机会来证实系统治疗的组织学反应，使一些患者无病，并可能促进选定患者的长期生存。
The role of surgery for RCC in the era of emerging effective systemic therapy (usually immunotherapy) is not yet defined except for solitary metastasis. The retrospective analysis of patients subjected to aggressive surgical management after systemic therapy reinforces the need to find better therapeutic modalities in order to achieve complete eradication of metastatic disease. In the meantime, however, we propose these guidelines. First, we would encourage aggressive surgical resection of the clinically solitary metastasis, whether synchronous or metachronous. Continue to follow those patients indefinitely, because relapse is quite likely, but do not give adjuvant systemic therapy unless on protocol. Second, limited metastases in only one organ may behave similarly to a solitary metastasis, and if the metastases are in a site amenable to surgical resection, e.g., lung, initial surgery might be reasonable. Systemic therapy for these patients is highly recommended and need not necessarily wait for recurrence. Third, for patients with multiple metastases, initial systemic therapy followed then by resection of any residual disease in selected patients seems to be supported by the experience at several medical centers. Apparently prolonged survival times have been observed after systemic therapy followed by surgery in highly selected patients, despite finding viable cancer in the overwhelming majority of specimens. One must be mindful of the morbidity of an attempt to remove all known disease, however, and try to weigh this against potential benefit. Only a prospective, randomized trial could ever confirm the value of an aggressive surgical approach to metastatic RCC. In the meantime, however, metastasectomy offers, at the very least, the opportunity to confirm the histologic response to systemic therapy, render some patients disease-free, and possibly promote long-term survival in selected patients.
肾癌患者远处孤立复发的治疗。
DOI：
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发表时间：
1994
期刊：
The Urologic clinics of North America
影响因子：
--
作者：
Kozlowski,JM
通讯作者：
Kozlowski,JM