Complex surgery and perioperative systemic therapy for genitourinary cancer of the retroperitoneum

Guideline Objective

To provide guidance on aspects of complex retroperitoneal surgical technique, including extent of resection and timing of surgery with respect to chemotherapy, and to investigate what other considerations are necessary to ensure safe surgery in this group of patients.

Patient Population

This guideline applies to people with metastatic testicular cancer, T3b or T4 or node positive and metastatic renal cell cancer and T3, T4 or node positive upper tract urothelial cancer[1].

Intended Guideline Users

This guideline is intended for genitourinary surgeons involved in retroperitoneal surgery, clinicians involved in the care of cancer patients who have received retroperitoneal surgery, and doctors referring patients for retroperitoneal surgery.

Research Question(s)

1. What is the most appropriate role for surgical intervention in patients with T3b, T4 or node-positive mRCC, metastatic UTUC, and metastatic testicular cancer?
2. Does neoadjuvant or adjuvant chemotherapy improve outcomes for patients receiving surgery for the treatment of T3b, T4 or node-positive metastatic renal cancer, metastatic UTUC, and metastatic testicular cancer?
3. Do patients with T3b, T4 or node-positive mRCC, metastatic UTUC, and metastatic testicular cancer have better oncologic outcomes and/or lower complications at higher volume or academic centres (compared to lower volume and community centres)?
4. Are there other considerations around implementation of surgery in patients with T3b, T4 or node-positive mRCC, metastatic UTUC and metastatic testicular cancer to ensure it is done safely?