Deferred Cytoreductive Nephrectomy With Partial Hepatectomy for Giant Renal Cell Carcinoma of the Right Kidney With Extensive Hepatic Invasion: A Case Report in the Era of Systemic Immune Checkpoint Inhibitors and Tyrosine Kinase Inhibitors
Yuki Hiroshi, Takamitsu Inoue, Takuya Minagawa, Masaki Takahashi, Akinobu Katami, Mizuki Onozawa, Masahiro Shinoda, Osamu Itano, Jun MiyazakiABSTRACT
Introduction
Deferred cytoreductive nephrectomy may improve the prognosis of patients with metastatic renal cell carcinoma (RCC). However, reports of combined hepatic resection for RCC with liver invasion are limited, and treatment strategies remain insufficiently established.
Case Presentation
A 75‐year‐old man presented with right RCC with liver invasion, lung metastases, and an inferior vena cava (IVC) tumor thrombus. Nivolumab plus cabozantinib reduced the lung metastases but not the primary tumor or thrombus. Three months after starting systemic therapy, he underwent open right nephrectomy, partial hepatectomy of segments 5, 6, 7, and part of 8, and tumor thrombus resection. Pathology revealed pT4, Grade 4 clear cell carcinoma. Although lung metastases recurred postoperatively, systemic therapy was resumed on day 51, resulting in complete remission.
Conclusion
Appropriately early cytoreductive nephrectomy with partial hepatectomy after systemic therapy may have contributed to this favorable outcome.