Renal cell carcinoma (RCC) that directly invades the colon is exceptionally rare, and treatment of such patients is particularly challenging. A recent article in Urology Annals describes the first reported case of colon-invading RCC that was managed with simultaneous open right radical nephrectomy and extended right hemicolectomy.
In addition to describing their surgical approach, the authors reported the results of a literature search of the PubMed, Scopus and EMBASE databases for similar, relevant reports that discussed management of colon-invading RCC.
The authors, led by Kevin Gerard Byrnes, of the Department of Urology at Beaumont Hospital in Dublin, Ireland, were prompted to conduct the literature review because of a lack of guidelines or prospective data to guide decision-making in this setting.
“Radical resection of locally advanced tumors is both challenging and controversial,” the authors wrote. “Clinical trials in oncology are conducted on the principle that tumor invasion to the surrounding structures renders the patient ‘inoperable.’”
They identified four reported cases of primary RCC invading the colon, in addition to their own case. Sarcomatoid differentiation was present in all five cases, indicating transformation to a more aggressive malignancy of a higher grade. “Sarcomatoid RCC (sRCC) is characterized by pleomorphic spindle cells and giant cells, producing a sarcoma-like appearance,” the authors explained. “Due to the locally invasive nature and metastatic potential of sRCC, it heralds a poor prognosis.”
Although the literature search did not find that en bloc resection improved overall survival, the approach led to improvements in symptoms, quality of life, and palliation.
The authors emphasized the importance of careful patient selection and clear resection of the involved structures, without which disease progression is likely. The authors also encouraged consideration of patient performance status, as well as levels of lactate dehydrogenase, serum hemoglobin, and corrected serum calcium.
As for the authors’ case, the patient recovered six months after surgery and had no evidence of disease recurrence. “The current case confirms radical resection is a feasible management strategy for similar presentations. En bloc resection of involved organs remains the only potentially curative option for locally advanced disease,” they wrote.
“Radical resection for locally advanced disease requires careful patient selection and counseling. Simultaneous resection of invaded structures with curative intent is feasible in select patients and can confer added benefits, including symptomatic control and improved quality of life,” they concluded.