Editor’s Note: Surgery is a fundamental treatment for renal cancer, particularly for patients with stage I and II cancers, where surgery can cure the majority of cases and ensure long-term survival. At the 2024 CSCO Annual Meeting, Urology Frontier invited Dr. Pei Dong from Sun Yat-sen University Cancer Center to discuss this year’s key updates in the CSCO guidelines for surgical treatment of renal cancer, comparisons between single-port and traditional laparoscopic nephrectomy, and the role of neoadjuvant therapy in enhancing surgical outcomes.

1. Key Updates in Renal Cancer Surgical Guidelines

Urology Frontier: What are the most prominent updates in the latest surgical guidelines for renal cancer?

Dr. Pei Dong: This year’s updates in the Chinese Society of Clinical Oncology (CSCO) guidelines for renal cancer surgery focus on three key areas. First, for patients with localized renal cancer who are unfit for surgery at stage T1b (maximum tumor diameter between 4cm and 7cm), the recommended management strategy aligns with stage T1a (tumor diameter ≤4cm), which includes observation, ablation, or stereotactic radiotherapy.

Second, it’s crucial to maintain a meticulous tumor-free principle during surgery for cystic renal carcinoma. When treating cystic renal cancer, the surgical approach should prioritize complete excision, avoiding rupture of the cystic fluid to prevent tumor dissemination.

Finally, regarding cytoreductive nephrectomy for metastatic renal cancer, the current recommendation is to perform systemic therapy followed by cytoreductive nephrectomy. This approach is particularly advantageous for intermediate- and high-risk metastatic patients, potentially providing improved survival outcomes.

2. Single-Port Laparoscopic vs. Traditional Laparoscopic Nephrectomy

Urology Frontier: How should single-port and traditional laparoscopic nephrectomy be selected for localized renal cancer?

Dr. Pei Dong: Overall, there is no fundamental difference between single-port and traditional laparoscopy in terms of surgical procedures. The key distinction lies in the surgical incision. Single-port laparoscopy is renowned for its minimally invasive and aesthetically pleasing nature, making it more suitable for patients with superficial tumors. This technique is not only easier to perform but also requires fewer surgical instruments, although it demands higher technical skills from the surgeon and can pose greater anatomical challenges. Consequently, single-port laparoscopy is better suited for patients with easily accessible tumors. Additionally, patients who place a high emphasis on cosmetic outcomes, such as young women, may prefer single-port laparoscopy due to its less visible scarring.

3. New Surgical Advances to Enhance Patient Outcomes

Urology Frontier: What new advances in renal cancer surgery do you see entering clinical practice soon to further improve patient outcomes?

Dr. Pei Dong: Significant progress has been made in renal surgery techniques in recent years. We are currently using the Da Vinci robotic system for nephron-sparing surgeries, which has led to a qualitative improvement in surgical procedures. In the past, patients needed to remain bedridden for a week post-surgery; now, they can get out of bed on the second day and be discharged within three days, significantly improving surgical efficiency.

For surgeons, the application of neoadjuvant therapy is also noteworthy. With increasing demand for nephron-sparing surgeries, especially for patients with impaired contralateral kidney function, the need to preserve renal function is paramount. However, larger or more complex tumors make nephron-sparing surgery more challenging. In such cases, combining targeted therapy with immunotherapy in neoadjuvant treatment can help shrink the tumor, reduce surgical complexity, and potentially eliminate micrometastases, thereby increasing the success rate of nephron-sparing surgery and reducing the risk of postoperative recurrence. Therefore, neoadjuvant therapy is likely to be a highlight of future research.

Dr. Pei Dong Chief Specialist in Renal Cancer, Sun Yat-sen University Cancer Center Professor, Master’s Supervisor, and Associate Chief Physician

• Doctoral training in joint program with Harvard University
• Deputy Head of the Rare Renal Cancer Group, Urogenital Cancer Committee, Chinese Anti-Cancer Association (CACA)
• Standing Member of the Youth Committee, CSCO
• Member of the CSCO Kidney Cancer Committee
• Secretary and Editorial Member of the CSCO Kidney Cancer Guidelines (2022-2023)
• Standing Member of the Integrated Chinese and Western Medicine Renal Cancer Committee, CACA
• Deputy Director of the Immunotherapy Branch, Guangdong Health Management Association
• Editor for the Chinese versions of JCO and CA
• Recognized as a “Good Doctor of Yangcheng,” recipient of the Camellia Award, and named an Excellent MDT Physician in Urology (2019, 2021)

Areas of Expertise:

• Comprehensive treatment of urological tumors, expert in full-course management of renal cancer
• Minimally invasive nephron-sparing treatment for complex renal tumors
• Surgery and postoperative adjuvant treatment of high-risk renal cancer
• Surgical treatment of complex retroperitoneal tumors