Kidney cancer: Every minute counts
European Multidisciplinary Meeting on Urological Cancers (EMUC) raised a vast array of controversial issues in onco-urology and offered essential updates, providing common ground for building bridges across disciplines.Organised by the European Association of Urology (EAU), the European Society for Medical Oncologists (ESMO) and the European Society for Radiotherapy and Oncology (ESTRO), the meeting took place on 4-6 November in Barcelona, Spain. More than 900 delegates, exhibitors and faculty joined the event, which proved to be highly interactive and stimulating.
The session dedicated to kidney cancer included two debates and a state-of-the art lecture on systemic treatment in metastatic disease, presented by Prof. C. Sternberg (IT). Prof. W. Artibani (IT), who formulated take-home messages in urology during the closing session of the 3rd EMUC, summarised some of the main insights in the field of RCC management.
”One clear message that we got from the session is that partial nephrectomy is now considered standard for T1a and T1b tumours,” he said. “This procedure can even be performed in selected cases on masses larger than 7cm in diameter.”
“Furthermore, it is vital to remember that every minute of warm ischemia time counts, for it determines the remaining function of the kidney,” he added.
Prof. Artibani strongly emphasised that the expertise of the surgeon remains to be the most important factor, as each technique has advantages and drawbacks. He pointed out that incision complications remain to be a challenge in the open nephrectomy, and touched upon the learning curve issues in the context of laparoscopic and robot assisted approaches. Intraoperative ultrasound and intraoperative fluorescence were also covered during the session.
The role of surgery in the management of metastatic disease is also gaining prominence, according to Artibani, who gave cytoreductive nephrectomy as an example.
“There are some uncertainties regarding the use of neoadjuvant targeted therapy, although we know for sure that biopsy of the tumour is always advised before TKI treatment.” said Artibani, referring to the arguments that had been presented by Prof. P. Mulders (NL) in his debate presentation.