He opined that this surgery performed in specialized centers is equivalent to open radical surgery in terms of OR time and size of tumors treated but is actually superior to the open technique in terms of decreased blood loss, shorter recovery time and hospital stay. He also described the technique of laparoscopic renal cryoablation and proposed this as a nephron sparing alternative in treating select patients with small tumors. More advanced cancer patients should have six monthly exams and imaging studies to include CT scans. Bone and brain imaging should be governed by symptoms.
Surgical therapy is useful for residual disease after cytokine therapy .
Surgery would confirm unrecognized complete responses, it may also render some pts disease free by removing occult disease and it can prolong survival in some patients. Observation after cytokine therapy is better than attempting surgical therapy for residual disease because the likelihood of these pts harboring occult metastases is high. Patients with multiple metastases and a high grade or sarcomatoid tumor should not undergo a cytoreductive nephrectomy prior to immunotherapy. These pts are at high risk for not having their symptoms palliated by surgery, of developing local recurrences, or dying within 6 months of diagnosis. A renal biopsy instead should be considered prior to initiating immunotherapy.