Background And Objective: For patients with resectable renal cell carcinoma (RCC), extirpative surgery with curative intent remains the standard of care. Despite surgical resection, most patients with high-risk features experience disease recurrence. The role of perioperative systemic therapy in the management of these patients' disease remains unclear. Several studies have evaluated the efficacy and safety of tyrosine kinase inhibitors (TKIs); however, most trials have yielded negative results. Adjuvant pembrolizumab demonstrated a disease-free survival benefit in the KEYNOTE-564 trial; however, multiple studies of other immune checkpoint inhibitors (ICIs) in a similar patient population did not yield consistent results. This review summarizes the current evidence for perioperative systemic therapy studies in RCC.
Methods: The PubMed, American Society of Clinical Oncology (ASCO), and clinicaltrials.gov databases were used to retrieve articles published from January 1, 2001 to December 31, 2023 using the following search terms: "adjuvant", "neoadjuvant", "perioperative", "VEGF inhibitors", "immune checkpoint inhibitors", and "renal cell carcinoma". The search was limited to articles published in English.
Key Content And Findings: We summarize the major perioperative systemic therapy studies in RCC patients and provide an analysis of study outcomes, comparing differences in trial design and patient selection. We also discuss ongoing trials and the emergence of novel biomarkers designed to improve patient selection.
Conclusions: The optimal use of perioperative systemic therapy in high-risk RCC is an area of active investigation. The use of adjuvant TKIs failed to demonstrate a survival benefit and was limited by high rates of toxicity. Several neoadjuvant and adjuvant ICI-based combination studies are being carried out to further improve clinical outcomes. Further studies will be needed to identify effective biomarkers to improve patient selection while avoiding overtreatment.
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http://dx.doi.org/10.21037/tcr-24-16 | DOI Listing |
Arch Orthop Trauma Surg
December 2024
Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of RUB-Bochum, Am Kokturkanal, 32545, Bad Oeynhausen, Germany.
Introduction: Total lower limb arthroplasties are standard orthopedic surgeries that are steadily increasing in modern civilization. In proportion, the number of revision arthroplasties and the corresponding financial burden for healthcare systems will increase. The present clinical investigation analyzed morbidities after aseptic revision knee arthroplasty.
View Article and Find Full Text PDFArch Orthop Trauma Surg
December 2024
Università Vita-Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy.
Introduction: Perioperative steroids administration in total joint arthroplasty gained popularity for pain relief, reduction of postoperative nausea and vomiting (PONV) and enhanced recovery. The purpose of this study is to systematically review and meta-analyze comparative results of prospective randomized trials focused on the effect of systemic steroid administration at different dosages in THA for hip osteoarthritis. The hypothesis is that perioperative systemic steroid administration has a positive impact on postoperative outcomes.
View Article and Find Full Text PDFBr J Anaesth
December 2024
Department of Anaesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China. Electronic address:
Background: Systemic inflammation after heart valve replacement surgery commonly results in complications including cognitive impairment. This study was designed to investigate whether valvular heart disease itself and inflammation after valve replacement surgery affects cognition and the related functional connectivity (FC) of the hippocampal memory network.
Methods: Forty-three patients with valvular heart disease were screened for recruitment and assessed with cognition function tests, blood inflammatory cytokine measurements, and functional magnetic resonance imaging scans before surgery and on postoperative day 7 and 30.
Medicine (Baltimore)
December 2024
Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China.
Rationale: Sacrococcygeal pilonidal disease (SPD) is a chronic inflammatory condition primarily affecting young males. This case report details the perioperative anesthetic management of a patient undergoing SPD surgery under subarachnoid anesthesia.
Patient Concerns: A 48-year-old obese male (body mass index 28 kg/m2) presented with recurrent sacrococcygeal swelling, pain, and purulent discharge for 2 months.
J Clin Monit Comput
December 2024
Division of Anesthesiology, Cleveland Clinic Abu Dhabi, Integrated Hospital Care Institute, Abu Dhabi, United Arab Emirates.
Perioperative anesthetic, surgical and critical careinterventions can affect brain physiology and overall brain health. The clinical utility of electroencephalogram (EEG) monitoring in anesthesia and intensive care settings is multifaceted, offering critical insights into the level of consciousness and depth of anesthesia, facilitating the titration of anesthetic doses, and enabling the detection of ischemic events and epileptic activity. Additionally, EEG monitoring can aid in predicting perioperative neurocognitive disorders, assessing the impact of systemic insults on cerebral function, and informing neuroprognostication.
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