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Feuer et al. J Cancer Metastasis Treat 2021;7:68 Journal of Cancer
DOI: 10.20517/2394-4722.2021.164
Metastasis and Treatment

Review Open Access

The contemporary role of metastasectomy in the
management of metastatic RCC

Zachary Feuer, Jacob I. Taylor, William C. Huang

Department of Urology, New York University Langone Health, New York, NY 10016, USA.
Correspondence to: Dr. William C. Huang, Department of Urology, New York University Langone Health, New York, NY 10016,
USA. E-mail: William.huang@nyulangone.org

How to cite this article: Feuer Z, Taylor JI, Huang WC. The contemporary role of metastasectomy in the management of
metastatic RCC. J Cancer Metastasis Treat 2021;7:68. https://dx.doi.org/10.20517/2394-4722.2021.164

Received: 14 Aug 2021 First Decision: 29 Sep 2021 Revised: 29 Sep 2021 Accepted: 26 Oct 2021 Published: 5 Dec 2021

Academic Editor: Hendrik Van Poppel Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Metastasectomy was initially described in the 1970s as a therapeutic strategy for patients with metastatic renal
cell carcinoma. Since that time, systemic therapy options have grown exponentially, most recently with the
introduction of immunotherapy. We aimed to review the contemporary literature regarding the role of
metastasectomy in the era of targeted therapy and immunotherapy. Historically, metastasectomy has benefited
patients with small volume, single-organ metastases, with favorable outcomes amongst younger, healthier patients
with metastases to specific sites. The interplay between the employment of metastasectomy and systemic therapy
has been limited to small, retrospective series with significant patient selection bias. More recently, investigators
have conducted randomized controlled trials exploring the use of targeted therapies in the adjuvant setting after
metastasectomy. Initial randomized data suggested no benefit in using sorafenib in this setting, and a subsequent
study demonstrated possible harm in using pazopanib after metastasectomy. However, the role of other novel
systemic therapies, including immunotherapy, nor the timing of use, have been meaningfully explored.
Metastasectomy appears to be a valuable therapeutic option in the properly selected patient, requiring a multi-
disciplinary management strategy and, pending future trials, a multimodal treatment approach.

Keywords: Clear-cell metastatic renal cell carcinoma, metastasectomy, immunotherapy

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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