The European Organisation for Research and Treatment of Cancer SURTIME trial explored timing of sunitinib, a tyrosine kinase inhibitor (TKI), and cytoreductive nephrectomy (CN) in patients with metastatic renal cell carcinoma. Previous retrospective studies suggest increased surgery-related adverse events (AEs) after presurgical TKI. We report surgical safety from a randomised comparison of CN before or after sunitinib. In-hospital mortality, 30-d readmission rate, and intraoperative and 30-d postoperative AEs according to Common Terminology Criteria for Adverse Events version 4 and Clavien-Dindo (CD) were analysed. Patients were randomised 1:1 to immediate CN followed by sunitinib versus sunitinib followed by deferred CN 24h after the last dose of sunitinib. None of the tumours in the deferred arm became unresectable, and only two patients had a sunitinib-related delay of CN of >2wk. AEs related to surgery (all grades) in the immediate and deferred arms occurred in 52% and 53% after CN, respectively, although the number of intraoperative surgery-related AEs was higher in the immediate arm. Postoperative AEs (CD ≥3), 30-d readmission, and in-hospital mortality rates were 6.5%, 13%, and 4.3% in the immediate arm and 2.5%, 7.5%, and 2.5% in the deferred arm, respectively. There were no differences in surgery time, blood loss, and hospital stay. PATIENT SUMMARY: Patients with metastatic kidney cancer do not have more surgical complications irrespective of whether they are treated with systemic therapy before or after surgery.

European urology. 2019 Jun 18 [Epub ahead of print]

Roderick Emile De Bruijn, Peter Mulders, Michael A Jewett, John Wagstaff, Johan V Van Thienen, Christian U Blank, Roland Van Velthoven, Lori Wood, Harm E van Melick, Maureen J Aarts, Jean B Lattouf, Thomas Powles, Igle J De Jong, Sylvie Rottey, Betrand Tombal, Sandrine Marreaud, Sandra Collette, Laurence Collette, John B Haanen, Axel Bex

The Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Urology, Radboud University Hospital, Nijmegen, The Netherlands., Department of Urology, Princess Margaret Hospital, Toronto, Ontario, Canada., Department of Oncology, Cardiff Hospital, Wales, UK., Department of Urology, Institut Jules Bordet, Brussels, Belgium., Division of Medical Oncology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada., Department of Urology, Saint Antonius Hospital, Nieuwegein, The Netherlands., Department of Oncology, Maastricht University Medical Center, Maastricht, The Netherlands., Department of Surgery Urology, University of Montreal Hospital Center, Quebec, Ontario, Canada., Department of Oncology, The Royal Free Hospital and Queen Mary University, London, UK., Department of Urology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium., Department of Urology, Cliniques Universitaires Saint-Luc, Brussels, Belgium., Department of Statistics, European Organisation for Research and Treatment of Cancer, Brussels, Belgium., The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: .