Surgical management of renal cell carcinoma invading the liver: A case report and systematic review

Abstract

OBJECTIVES: This study aims to perform the first systematic review of the operative techniques of simultaneous radical nephrectomy with hepatic resection for renal cell carcinoma (RCC) with direct hepatic extension. This will also help to understand the demographics, clinical presentation, prevalent histological subtypes, management, the outcomes and to report a case of collecting duct RCC invading the liver who underwent simultaneous nephrectomy with hepatic resection. DATA SOURCES: PubMed, EMBASE, and Scopus databases. STUDY SELECTION: We searched the articles between the years 1991 to 1st April 2021 in the English language. Case reports, case series, and matched cohort studies were included. Eligible studies reported renal mass characteristics with nature of extension, histopathological features, operative manoeuvres, and outcomes. DATA EXTRACTION: Data were extracted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. RESULTS: The initial search strategy yielded 33 results in PubMed, 34 in Scopus, and 81 in EMBASE database, of which six articles were found eligible for review. The mean size of tumour was >10 cm and with a mean age of 51-67 years. All cases had RCC with direct extension to the liver, and all underwent simultaneous nephrectomy with liver resection with a technique of liver hanging manoeuvre used commonly. The most common histological type was clear cell carcinoma. The mean blood loss was 3.3 liters, and the mean hospital stay was 9.75 days. CONCLUSIONS: A review of the currently available literature shows that the invasion to surrounding structures, including the liver by the RCC is not so common, and it possesses a treatment challenge for the clinician. Currently, en bloc surgical removal with anatomical or non-anatomical resection of the liver is the only modality that provides the best chance of control for the RCC with direct hepatic extension, although a frail patient may not afford this. Adjuvant therapies for RCC with the liver infiltration should be individualised based on histopathology. Collecting duct carcinoma is an aggressive malignancy, early diagnosis and surgical resection with a multidisciplinary approach are indispensable in eligible patients.