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IN THE NAME OF GOD. LOCAL RECURRENCE OF RCC AFTER PN OR RN. MEHRDAD MOHAMMADI MD ENDOUROLOGY & LAPAROSCOPY. EVALUATION. the majority of patients with local recurrence also have systemic disease, and a thorough metastatic evaluation should be pursued.
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LOCAL RECURRENCE OF RCC AFTER PN OR RN MEHRDAD MOHAMMADI MDENDOUROLOGY & LAPAROSCOPY
EVALUATION • the majority of patients with local recurrence also have systemic disease, and a thorough metastatic evaluation should be pursued.
Surgical resection of isolated local recurrence of RCC after radical nephrectomy should be considered, because it can provide long-term cancer-free status for 30% to 40% of patients.
Complete resection of abdominal recurrences is often a formidable task because the natural tissue barriers are no longer present and invasion of contiguous organs is common. • En-bloc resection of adjacent organs is often required, and the risk of morbidity can be substantial.
Recent data confirm that local recurrence after PN is uncommon, even with a positive surgical margin • (Permpongkosol et al, 2006; Kwon et al, 2007; Kutikov et al, 2008b; Yossepowitch et al, 2008)
Most of these local recurrences are distant from the tumor bed and are thus probably a result of unrecognized tumor multicentricityor de novo occurrence rather than true treatment failure.
Patients with isolated local recurrence after PN can be considered for repeat PN, completion nephrectomy, TA, or AS.
From 1970 to 1998 the incidence of isolated renal bed recurrence among 1,737 T1-3NOMO unilateral nephrectomy cases was 1.8%. • There were 30 patients.
Patients were divided into 3 treatment groups of observation (9), therapy excluding surgical extirpation (11) and complete surgical resection alone or in conjunction with additional therapy (10).
patients who underwent surgical resection had an improved 5-year cause specific survival rate of 51% compared to 18% treated with adjuvant medical therapy and 13% with observation alone.
retrospectively analyzed 16 patients who were treated surgically at our institution for suspected isolated local renal cell carcinoma recurrence during the last 10 years.
All patients had undergone extensive staging and had no evidence of distant metastases with the local recurrence.
Surgical exploration confirmed carcinoma recurrence in 13 of the 16 cases and all 13 patients underwent complete resection of the local recurrence.
Three patients were found to have had false-positive computerized tomography findings on surgical exploration.
Only 2 patients were symptomatic, while in 11 disease had been detected at routine follow up.
Of the patients 7 died of metastatic disease after a mean survival of 23.1 months (range 4 to 68) following recurrence removal and 6 are alive with a mean survival of 53.0 months
Conclusions • Careful followup after radical nephrectomy for renal cell carcinoma allows the diagnosis of small local recurrences before they become symptomatic in the majority of cases.
Although most of these patients will eventually have and die of metastatic disease, an aggressive surgical approach is justified and can result in prolonged survival.
RECURRENCE SITES • Renal fossa • Ipsilateral adrenal gland • Ipsilateral retroperitoneal lymph nodes
TAKE HOME MESSAGE • Aggressive surgical treatment has frequently been advocated as the best available therapy. Multiple studies have shown that an aggressive surgical approach is effective in prolonging survival.
