Cytoreductive nephrectomy preceding adjuvant immunotherapy for metastatic renal cell carcinoma: 8 years' experience in a UK tertiary referral centre

Objective: We report a tertiary referral centre's experience of cytoreductive nephrectomy (CN) combined with immunotherapy as part of multimodality treatment for metastatic renal cell cancer (mRCC) over a period of 8 years. Patients and methods: Patients who underwent CN as part of multimodality treatment for mRCC were identified from our nephrectomy database. Demographic characteristics, oncological outcome, reasons for failure to start or to complete immunotherapy, pathological findings and a comparison between open and laparoscopic CN were evaluated. Results: Forty patients underwent CN for mRCC preceding immunotherapy. 26 (65%) failed to receive immunotherapy. This was most commonly due to poor performance status postoperatively (12/26, 46%). 14 patients (35%) received immunotherapy following surgery and 9 (23%) patients completed treatment. Laparoscopic CN was associated with a significantly lower blood loss, shorter hospital stay and lower rate of transfusion than the open approach. Conclusion: Patients are at significant risk of failure to proceed to adjuvant immunotherapy following CN for mRCC, most commonly due to poor performance status postoperatively. Laparoscopic CN is shown to be safe and effective in well-selected patients. As new targeted treatments for mRCC emerge and their use in combination with CN is evaluated, a detailed and multidisciplinary approach to selection of these patients will continue to be crucial