Editing Management of Localized and Locally Advanced Disease (section)

=== Locally invasive RCC (cT4N0M0) ===

* '''<span style="color:#ff0000">Management</span>'''
** '''<span style="color:#ff0000">Complete resection of disease through RN with resection of adjacent organs, if feasible</span>'''
*** '''Because surgical therapy is the only potentially curative management for RCC, extended operations with en bloc resection of adjacent organs are occasionally indicated.'''
**** Removing all known disease, with possible concomitant resection of involved organs, such as the adrenal gland, liver, pancreas, diaphragm, and bowel is the aim of therapy.
**** '''Incomplete excision''' of a large primary tumor, '''or <span style="color:#ff0000">debulking, is rarely indicated</span>''' as survival estimates are only 10-20% at 12 months
**** '''<span style="color:#ff0000">Vaccination against Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitides should be performed preoperatively in those without previous vaccination when splenectomy is likely during nephrectomy</span>'''
*** Even with an aggressive surgical approach the prognosis remains poor and the oncological benefits of surgery should be carefully considered in the context of surgical morbidity
*** Regional lymphadenectomy should be considered for adequate pathologic staging