The role of surgery in renal cell carcinoma

Renal cell carcinoma accounts about three percent of all adult neoplasms. T his review provides a current status about the surgical management of renal cell carcinoma. In localised carcinomas radical nephrectomy is still the s tandard treatment and provides 5 Year survival rates up to 98 %. As nephron -sparing surgery in mandatory indications can achieve similar survival doub t can be expressed whether lymphadenectomy or adrenalectomy are necessary i n every case. Nephron-sparing surgery is associated with a higher rate of o perative complications up to 40 % and probably with a higher risk of local recurrence. However, parenchymal-sparing surgery in elective indications is possible for small tumors, if long term follow up is guaranteed. But there is no convincing advantage of nephron-sparing surgery to recommend this pr ocedure as a general approach in patients with a normal contralateral kidne y. Radical surgery in renal carcinomas invading to the vena cava still rema ins a challenging surgical intervention. Nevertheless,in selected patients surgery can realise long term survival in over a third of cases. Palliative nephrectomy in metastatic renal carcinomas is only justified in real palli ative indications (bleeding, pain) or in clinical trials investigating cyto reductive surgery before immunotherapy. In highly selected patients with me tastatic renal carcinoma a radical surgical approach including nephrectomy and complete metastasectomy can achieve long term survival.