藉由機械手臂鞏固手術達到轉移性腎癌腹膜轉移之無病生存狀態：病例報告

黃建翔、余家政、陳逸軒

高雄榮民總醫院 外科部 泌尿外科

Achieving No Evidence of Disease (NED) in Metastatic Renal Cancer with Peritoneal Seeding via Robotic Consolidation: A Case Report

Chien-Hsiang Huang, Chia-Cheng Yu, I-Hsuan Chen

Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital

Introduction

Metastatic renal cell carcinoma (mRCC) presenting with peritoneal carcinomatosis is an exceptionally rare clinical entity, occurring in approximately 1% of cases. Historically, this condition has been associated with a guarded prognosis, with five-year survival rates historically reported between 0% and 20%. While systemic therapy remains the cornerstone of management, the paradigm of surgical metastasectomy (SM) has evolved. Emerging evidence suggests that achieving complete resection (CR) or a "no evidence of disease" (NED) status significantly improves cancer-specific and overall survival (OS) compared to incomplete or no resection, particularly in selected patients.

Case Presentation

A 71-year-old male with a history of benign prostatic hyperplasia presented with intermittent painless gross hematuria. Imaging identified a solid mass in the left kidney. In April 2024, the patient underwent robotic-assisted radical nephroureterectomy (RARNU) with bladder cuff excision. Histopathological examination confirmed clear cell renal cell carcinoma (ccRCC), WHO/ISUP grade 4, staged as pT3aN0M0 (Stage III). Although adjuvant pembrolizumab was recommended based on the KEYNOTE-564 protocol, the patient opted for surveillance.

In July 2025 (15 months post-operatively), surveillance CT revealed multifocal recurrence involving the left renal fossa, para-aortic region, and pelvic peritoneum. In August 2025, the patient underwent robotic-assisted metastasectomy. Pathological analysis of the retroperitoneal and para-aortic lesions confirmed metastatic ccRCC. Postoperatively, the patient initiated systemic therapy with cabozantinib. As of his most recent follow-up, he remains in clinical remission with no evidence of recurrence.

Discussion 

The primary objective of SM in the era of targeted therapy and immune checkpoint inhibitors (ICIs) is to achieve M1 NED status. Literature indicates that patients achieving CR through SM exhibit a median OS ranging from 36.5 to 142 months, a stark contrast to the 8.4 to 27 months observed in those with residual disease.

In this case, the rapid progression within 15 months posed a therapeutic challenge. For patients with early relapse or high-volume oligometastatic disease, a multimodal approach—integrating cytoreductive surgery with potent TKIs like cabozantinib—is essential. This case highlights that robotic platforms allow for precise dissection of multifocal peritoneal seeds while minimizing surgical morbidity, facilitating a prompt transition to systemic agents.

Conclusion

This case illustrates that robotic-assisted metastasectomy is a feasible and effective component of a multimodal strategy for mRCC with peritoneal dissemination. Successful outcomes hinge on rigorous patient selection, prioritizing those with a favorable performance status and resectable disease volume. The synergy between surgical consolidation and contemporary systemic therapies (TKIs/ICIs) offers a promising pathway for extending survival in this high-risk population.