Neoadjuvant Surgical Enablement in Renal Cell Carcinoma: Systematic Review and Meta-analysis
In brief
Neoadjuvant drugs allow partial kidney removal in 80% of RCC cases
A meta-analysis of 34 studies found that pre-operative systemic therapy enabled partial nephrectomy in about four-fifths of patients with localized or locally advanced renal cell carcinoma, while also achieving tumor shrinkage in one-third and venous thrombus downstaging in roughly half. Serious side effects occurred in 28% and postoperative complications in 13%, and the evidence quality was low, so routine use is not yet justified.
- Journal
- Clinical genitourinary cancer (Q1)
- Published
- 26 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Yucong Chai, Erhao Bao, Bohao Zhong, Chuan Zhang, Liming Zhang, Yuqi Jiang, et al.
- PMID
- 42896503
- DOI
- 10.1016/j.clgc.2026.102688
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 21 October 2026): Neoadjuvant systemic therapy enabling surgery in renal cell carcinoma
Abstract
Neoadjuvant systemic therapy is increasingly considered for selected patients with localized or locally advanced renal cell carcinoma (RCC) when the intended value is not merely tumor shrinkage but surgical enablement, including partial nephrectomy achievement, venous tumor thrombus downstaging, or simplification of the planned operation. We synthesized the evidence on neoadjuvant or preoperative systemic therapy as a surgical-enabling strategy in RCC. PubMed/MEDLINE, Web of Science Core Collection, the Cochrane Library, and Embase were searched from inception to 1 May 2026. Eligible reports included adults with localized or locally advanced RCC treated with neoadjuvant or preoperative systemic therapy before surgery or surgical reassessment and reporting extractable surgical, radiographic, pathologic, or safety outcomes. Random-effects single-arm meta-analyses used non-overlapping outcome-level denominators. Thirty-four eligible study records were included. Pooled rates were 0.80 for partial nephrectomy achievement, 0.32 for objective response, 0.44 for venous tumor thrombus or Mayo-level downstaging, 0.42 for surgical strategy simplification, and 0.11 for pathologic complete response or ypT0. Grade ≥ 3 treatment-related adverse events occurred at a pooled rate of 0.28; among operated patients, Clavien-Dindo grade ≥ III postoperative complications occurred at a pooled rate of 0.13. Certainty was low or very low. Neoadjuvant systemic therapy may support individualized surgical enablement in selected RCC patients, but current evidence does not justify routine use outside carefully defined multidisciplinary decision-making or prospective trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.