Kidney Cancer Association

Renal cancer often requires nephron-sparing surgery for optimal patient outcomes. Despite advances in imaging and robot-assisted surgery, there is a need to enhance surgical precision and renal preservation. This trial evaluates the effectiveness of three-dimensional image-guided robot-assisted partial nephrectomy versus standard methods in improving surgical outcomes. This trial is a prospective, 1:1 randomized, single-blind phase 3 superiority study conducted across 14 centers within the French Network for Research on Kidney Cancer, aiming to enroll 694 patients over 36 mo. The primary endpoint is a composite trifecta score, including negative surgical margins, no complications, and renal function preservation (estimated glomerular filtration rate >90% at 1mo). The secondary endpoints include oncological outcomes, conversion rates, perioperative parameters, and economic evaluation. Data are collected via the UroCCR database. Logistic regression will analyze the primary endpoint, and various regression methods will address the secondary outcomes. Economic evaluations involve incremental cost-utility and cost-effectiveness ratios. Strengths include the multicenter design and robust randomization. Limitations involve variability in surgeons' experience with the new three-dimensional technology and logistical challenges in technology adoption. This clinical trial is designed to evaluate a new surgical technique for treating kidney tumors called three-dimensional (3D) image-guided robot-assisted partial nephrectomy. This study aims to determine whether this new method is more effective and safer than the current standard robot-assisted surgery by improving surgical precision and preserving kidney function. Kidney tumors require precise surgical removal to ensure the best outcomes for patients both during and after surgery. While robotic assistance has improved many surgeries, use of advanced 3D imaging during these procedures might enhance the surgeon's ability to operate with greater accuracy, potentially leading to better patient outcomes and fewer complications. Participants in the trial will undergo surgery using either the conventional robotic-assisted method or the new 3D image-guided technique. The method used for each participant will remain undisclosed to maintain the study's integrity. All participants will receive the highest standard of care, and their progress will be monitored closely throughout the trial. This study hopes to demonstrate that the 3D image-guided method can improve surgical precision and outcomes for patients undergoing kidney tumor removal. If successful, this technique could set a new standard for kidney surgery and improve the overall care patients receive in the future. The addition of 3D reconstruction to the surgery carries very little extra risk. If any technical issues occur, the surgeons can switch back to the regular method without affecting safety. The 3D technology we use, Synapse 3D, is approved and used in hospitals worldwide, ensuring that its safety is well proven by existing evidence.

Modern advances in systemic and localized therapies for patients with renal cell carcinoma (RCC) have significantly improved patients’ outcomes. If disease progression occurs after initial treatment, clinicians often have multiple options for a first salvage therapy. Because salvage and initial treatments both may affect overall survival time, and they may interact in unanticipated ways, there is a growing need to determine sequences of initial therapy and first salvage therapy that maximize overall survival while maintaining quality of life. The complexity of this problem grows if a second salvage therapy must be chosen for patients with treatment-resistant disease or a second progression occurs following first salvage. On November 9, 2023, a think tank was convened during the International Kidney Cancer Symposium (IKCS) North America to discuss challenges in accounting for postprogression therapies when estimating overall survival (OS) time based on randomized controlled trial (RCT) data. The present manuscript summarizes the topics discussed, with the aim to encourage adoption of statistical methods that account for salvage therapy effects to obtain scientifically valid OS estimation. We highlight limitations of traditional methods for estimating OS that account for initial treatments while ignoring salvage therapy effects and discuss advantages of applying more sophisticated statistical methods for estimation and trial design. These include identifying multistage treatment strategies, correcting for confounding due to salvage therapy effects, and conducting Sequentially Multiple Assignment Randomized Trials (SMARTs) to obtain unbiased comparisons between multistage strategies. We emphasize the critical role of patient input in trial design, and the potential for information technology (IT) advances to support complex trial designs and real-time data analyses. By addressing these challenges, future RCTs can better inform clinical decision-making and improve patient outcomes in RCC.

This American Head and Neck Society (AHNS) consensus statement focuses on evidence-based comprehensive pain management practices for thyroid and parathyroid surgery. Overutilization of opioids for postoperative pain management is a major contributing factor to the opioid addiction epidemic however evidence-based guidelines for pain management after routine head and neck endocrine procedures are lacking. An expert panel was convened from the membership of the AHNS, its Endocrine Surgical Section, and ThyCa. An extensive literature review was performed, and recommendations addressing several pain management subtopics were constructed based on best available evidence. A modified Delphi survey was then utilized to evaluate group consensus of these statements. This expert consensus provides evidence-based recommendations for effective postoperative pain management following head and neck endocrine procedures with a focus on limiting unnecessary use of opioid analgesics.

Immunotherapy has produced durable clinical benefit in patients with metastatic renal cell cancer (RCC). In the past, patients treated with interferon-alpha (IFN) and interleukin-2 (IL-2) have achieved complete responses, many of which have lasted for multiple decades. More recently, a large number of new agents have been approved for RCC, several of which attack tumor angiogenesis by inhibiting vascular endothelial growth factors (VEGF) and VEGF receptors (VEGFR), as well as tumor metabolism, inhibiting the mammalian target of rapamycin (mTOR). Additionally, a new class of immunotherapy agents, immune checkpoint inhibitors, is emerging and will play a significant role in the treatment of patients with RCC. Therefore, the Society for Immunotherapy of Cancer (SITC) convened a Task Force, which met to consider the current role of approved immunotherapy agents in RCC, to provide guidance to practicing clinicians by developing consensus recommendations and to set the stage for future immunotherapeutic developments in RCC.