J.Jpn. Surg. Soc.. 127(2): 206-212, 2026

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Feature topic

SURGERY FOR GENITOURINARY CANCERS IN THE IMMUNE CHECKPOINT INHIBITOR ERA

Among urological cancers, immune checkpoint inhibitors (ICIs) are covered by social insurance only for renal cell carcinoma (RCC) and bladder cancer (BC) (urothelial carcinoma), and their effectiveness has not yet been confirmed for prostate cancer or testicular cancer. For RCC, there have been reports of cases of solitary kidneys in which preoperative treatment with molecular-targeted drugs has enabled limited surgery (not radical but partial nephrectomy), but this is not common. The same remains true after the introduction of ICIs. In cases with metastasis, cytoreductive nephrectomy (CN) and metasectomy have traditionally been performed. Since the introduction of molecular-targeted drugs and ICIs, CN has been performed only in limited cases where systemic treatment is successful. For BC, perioperative administration of ICIs has been approved, but the impact has not yet been proven to change the surgical procedure (i.e., radical vs. partial cystectomy). However, highly locally advanced BC, such as that associated with multiple regional lymph node metastases, may become eligible for surgery with intensive treatment including ICIs. Conversion surgery and metastasectomy are rare in cases of BC with distant metastasis, and this situation has not changed significantly even in the ICI era.

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