CYTOREDUCTIVE SURGERY FOR STAGE-IV RENAL-CELL CARCINOMA

To facilitate the regression of extra renal disease in response to sys temic therapy, cytoreductive surgery has been advocated as step 1 in t he treatment of stage IV renal cell carcinoma. To determine the effect of surgery on subsequent clinical course, we reviewed the treatment r ecords of 30 patients with known stage TV carcinoma of the kidney who underwent nephrectomy or additional procedures in preparation for syst emic therapy. Of 30 patients only 7 (23%) underwent systemic therapy p ostoperatively. Progression of the disease, surgical morbidity and mor tality were the factors preventing 77% of our patients from continuing with treatment. Since regression of extra renal lesions is the goal o f systemic therapy, our data suggest that nephrectomy and most other c ytoreductive operations in preparation for systemic therapy are not ef ficient treatment strategies.