Complex surgery and perioperative systemic therapy for genitourinary cancer of the retroperitoneum

  • A. Finelli Princess Margaret Cancer Centre, University Health Network, University of Toronto, and Ontario Health (Cancer Care Ontario)
  • N. Coakley McMaster University, and Ontario Health (Cancer Care Ontario), Program in Evidence- Based Care
  • J. Chin London Health Sciences Centre, and University of Western Ontario
  • T. A. Flood The Ottawa Hospital, Ottawa
  • A. Loblaw Sunnybrook Health Sciences Centre and University of Toronto
  • C. Morash University of Ottawa
  • B. Shayegan McMaster University and St. Joseph’s Healthcare
  • R. Siemens Queen’s University, and Kingston General Hospital
Keywords: Ontario Health (Cancer Care Ontario), surgery, systemic treatment, testicular cancer, metastatic, renal cell cancer, T3b or T4, or node-positive, and metastatic, urothelial cancer, upper tract, T3, T4, guideline recommendations

Abstract

Objective The purpose of the present guideline is to recommend surgical or systemic treatment for metastatic testicular cancer; T3b or T4, or node-positive, and metastatic renal cell cancer (rcc); and T3, T4, or node-positive upper tract urothelial (utuc) cancer.

Methods Draft recommendations were formulated based on evidence obtained through a systematic review of randomized controlled trials, comparative retrospective studies, and guideline endorsement. The draft recommendations underwent an internal review by clinical and methodology experts, and an external review by clinical practitioners.

Results The primary literature search yielded eight guidelines, five systematic reviews, and twenty-seven primary studies that met the eligibility criteria.

Conclusions Cytoreductive nephrectomy should no longer be considered the standard of care in patients with T3b or T4, or node-positive, and metastatic rcc. Eligible patients should be treated with systemic therapy and have their primary tumour removed only after review at a multidisciplinary case conference (mcc). Adjuvant sunitinib after surgery is not recommended. Patients with venous tumour thrombus should be considered for surgical intervention. Patients with T3, T4, or node-positive utuc should have their tumour removed without delay. Decisions concerning lymph node dissection should be done at a mcc and be based on stage, expertise, and imaging. Adjuvant systemic treatment is recommended for resected high-risk utuc. Patients with metastasis-positive testicular cancer with residual tumour after systemic treatment should be treated at specialized centres. For all complex retroperitoneal surgeries, the evidence shows that higher-volume centres are associated with lower rates of procedure-related mortality, and patients should be referred to higher-volume centres for surgical resection.


Author Biographies

N. Coakley, McMaster University, and Ontario Health (Cancer Care Ontario), Program in Evidence- Based Care
Department of Oncology
T. A. Flood, The Ottawa Hospital, Ottawa

Department of Anatomic Pathology

C. Morash, University of Ottawa
Department of Surgery
R. Siemens, Queen’s University, and Kingston General Hospital
Department of Urology
Published
2020-03-06
How to Cite
Finelli, A., Coakley, N., Chin, J., Flood, T. A., Loblaw, A., Morash, C., Shayegan, B., & Siemens, R. (2020). Complex surgery and perioperative systemic therapy for genitourinary cancer of the retroperitoneum. Current Oncology, 27(1). https://doi.org/10.3747/co.27.5713
Section
Practice Guideline