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Published in Renal Cell Carcinoma

Expert Opinion / Cases · October 06, 2015

Small Bowel Obstruction Secondary to a Solitary Jejunal RCC Metastasis

George Yaghmour MD

 

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George Yaghmour MD

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  • Andrew Fintel

    Oct 13, 2015

    Interesting case with a very unusual place for a recurrence of RCC. In this patient who had gone 19 years from removal of his RCC to recurrence, he was then treated with a metastatectomy with no other evidence of disease. You could assume that his tumor biology is less aggressive given the long TTR and for this reason plan for no systemic therapy extrapolating data from the ASSURE trial which tells us that there is no role for Sunitinib or Sorafenib as Adjuvant therapy. On the other hand there are some retrospective trials showing improved PFS when giving TKIs post metastatectomy. 
For this patient I would consider holding off on giving systemic therapy as he had such a long time to relapse and knowing that TKIs do have real side effects, and then reserve using your TKI for another relapse which may not occur for a while. 
To answer the second question, I do not think doing an EGD would be a cost effective screening strategy even in this patient with an odd place for a recurrence. I think regular follow up modalities for metastatic disease would do and leaving endoscopy for symptoms of GI involvement.

  • George Yaghmour

    Oct 26, 2015

    Thanks for your inputs. I think it is reasonable to watch and wait as far the patient underlying cancer biology is not that aggressive. I agree that standard of care follow up surveillance is appropriate and would consider endoscopy for symptoms as needed.

  • Nov 25, 2024

    Pending Moderator approval.
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