Multivisceral Resection for Locally Advanced Renal Cell Cancer: A Systematic Review of the Literature

Introduction: Patients with Locally Advanced Renal Cell Cancer (LARCC) may be subjected to multivisceral resection (MVR) of invaded organs to achieve R0 resection and local disease control. The aim of the present study was to systematically review all available literature on the postoperative and long-term outcomes of MVR for RCC and highlight its role in current oncologic treatment strategies. Material and Methods: The PubMed, Scopus and Cochrane databases were systematically searched by two independent investigators for studies concerning MVR for LARCC. Results: In total, 10 original studies including 474 patients met our inclusion criteria. The female:male ratio was 1:1.8 and the median age varied from 56 to 64 years. Regarding patients’ symptoms, 47.83% (95% CI, 40.1–55.01%) of the patients presented with local clinical symptoms and 44.02% (95% CI, 37.04–53.50%) of patients with systematic symptomatology, while only 8.15% (95% CI, 4.91–13.1%) of patients were asymptomatic and were diagnosed incidentally. The median tumor size measured between 10 cm and 14.5 cm. Seven articles (161 patients) assessed the histologic findings of the RCC, with the majority (83.5%) classified as the clear cell type. Lymphovascular invasion was reported in 32 tumor specimens, tumor necrosis in 45 patients and sarcomatoid features in 55 specimens. Radical nephrectomy (RN) combined with resection of one organ was performed in 86.65% (95% CI, 82.85–89.7%) of patients, while RN along with resection of more than one was performed in 13.35% (95% CI, 10.3–17.15%) of patients. The liver, the large bowel, the spleen and the adrenal glands were the most frequently resected organs for MVR. Regarding survival, three studies reported survival data with a median cancer-specific survival ranging from 10 to 36 months. Conclusions: Radical nephrectomy combined with MVR of adjacent organs is feasible and both patient and tumor characteristics should be carefully assessed to optimize candidate selection. Whether MVR can offer a survival advantage remains to be determined and further well-designed studies are needed.