Challenging Radical Nephrectomy after Treatment with Nivolumab

Advanced Renal Cell Carcinoma (RCC) is a lethal urologic neoplasm. In cases of local progression and symptoms or in the case of a complete or significant response in the metastatic sites after systemic therapies, Cytoreductive Nephrectomy (CN) is selectively considered. Recently, it has been suggested that the use of Immune Checkpoint Inhibitors (ICIs) prior to CN could be associated with increased fibrosis and adhesions in and around the affected kidney, although the literature is scarce and controversial in this regard. Some authors postulate that the induction of the inflammatory reaction caused by ICIs on the tumours may result in significant perioperative morbidity. Aiming to contribute to the elucidation of this matter, we report a case in which nivolumab was used prior to a difficult CN in a patient with metastatic RCC, leading to an increased difficulty in performing the surgery.