The role of hepatic and pancreatic metastatectomy in the management of metastatic renal cell carcinoma: A systematic review.

Surgical resection is feasible in a small proportion of patients with oligometastatic renal cell carcinoma (mRCC) involving the liver or pancreas. The aim of this study was to evaluate the effect of liver and pancreatic resection or ablation for mRCC on survival and to identify factors associated with improved outcomes. A systematic search of the Medline and EMBASE databases was performed to identify studies reporting outcomes following hepatic or pancreatic resection or ablation for mRCC. The study was conducted according to PRISMA guidelines. A total of 35 studies reporting pancreatic resection outcomes and 14 studies reporting hepatic resection for mRCC were identified. There were no randomised controlled trials. Median overall survival (OS) following liver resection ranged from 16 to 142 months and 5-year OS from 14.7 to 62%. Following pancreatic resection, median OS ranged from 6 to 106 months and 5-year OS from 26 to 88%. Metachronous presentation and a longer DFI from resection of the primary tumour were associated with better survival outcomes. Mortality following liver and pancreatic resection was 2.7% and 4.2%, whilst significant morbidity (Clavien-Dindo Grade 3a or above) was reported in 20.9% and 25.4% of cases respectively. Liver or pancreatic resection or ablation for oligometastatic RCC may benefit a very select group of patients and they should be discussed within a hepatopancreatobiliary multidisciplinary tumour board meeting. Further studies are required to further define patients most likely to benefit, including potential utilization of molecular precision oncology strategies.

Real world outcomes of biopsy-proven oncocytic neoplasm of the kidney managed by surveillance.

Objectives: To evaluate outcomes of patients diagnosed with oncocytic renal neoplasms on routine renal mass biopsy and to describe the natural history of these tumours when managed with surveillance as opposed to immediate intervention. To report disease-specific survival. Patients and methods: Patients were identified from a retrospective review of pathology databases from three tertiary referral centres that utilise renal mass biopsy in routine clinical practice. All patients with biopsy-proven oncocytic tumours were included and a retrospective review of online patient records was undertaken. Results: There were 184 biopsy-proven oncocytic renal neoplasms identified in 172 patients. There were two biopsy complications (both pneumothorax, Clavien-Dindo Grade I). Of these lesions, 135 were reported as oncocytomas or oncocytic renal neoplasms that were not further classified and 37 were reported as chromophobe carcinoma (ChRCC). The median age at diagnosis was 70 (33-88). The average tumour diameter at diagnosis was 33 mm. One hundred seven tumours were initially managed with surveillance (including 13 ChRCC) with a minimum follow-up of 6 months and a median of 39 months (6-144) whereas 49 patients underwent immediate treatment. The mean growth rate across all oncocytic renal neoplasms managed by surveillance was 3 mm/year. There was no statistically significant difference in growth rates between oncocytic renal neoplasms and ChRCC. Thirteen patients with oncocytic renal neoplasms initially managed by surveillance moved on to an active management strategy during follow-up. The clinical indication given for a change from surveillance was tumour growth in 12 cases and patient choice in 1 case. Where definitive pathology was available, there was 85% concordance with the biopsy. There were no cases of development of metastatic disease or disease-related morbidity or mortality during the study. Conclusions: This multicentre retrospective cohort study supports the hypothesis that selected biopsy-proven oncocytic renal neoplasms can be safely managed with surveillance in the medium term. Routine renal mass biopsy may reduce surgery for benign or indolent renal tumours and the potential associated morbidity for these patients.