Dr. Castle on Minimally Invasive Surgical Approaches in RCC

Erik P. Castle, MD, professor of urology, Mayo Clinic, discusses minimally invasive surgical approaches in renal cell carcinoma (RCC).

Robotic surgery is used in any stage III or higher RCC or renal mass, as it allows surgeons to reconstruct the vena cava if there is caval thrombus and do an extensive lymphadenectomy. Although lymphadenectomy has not been shown to confer a significant survival advantage, it does help with staging, says Castle. The procedure also helps determine whether adjuvant therapy is necessary in patients with locally advanced disease. At Mayo Clinic, thoracic surgeons can perform a minimally invasive lung resection in a patient who has metastases on the ipsilateral side of the lung during cytoreductive nephrectomy, adds Castle.

In a patient who has a solitary kidney mass, with oligometastatic disease and a lesion that could be resected with partial nephrectomy, surgeons will perform partial cytoreductive nephrectomy, local disease resection, and potentially a metastasectomy. The goal of the procedure is to preserve the patient’s kidney function, so that they can receive systemic therapy. In addition to less aggressive surgical approaches, the field is going to move towards image guidance throughout surgery, concludes Castle.