SEARCH

SEARCH BY CITATION

Keywords:

  • kidney;
  • nephrectomy;
  • local recurrence;
  • neoplasm

The local recurrence of renal cancer is an uncommon event, but it is often tempting to remove such recurrences surgically. Authors from the USA analysed the survival benefit of such a strategy in the presence and the absence of concomitant metastatic disease. They found that, in the absence of metastases, complete surgical resection of local recurrences is associated with improved survival.

Authors from the same institution compared outcomes in elective partial vs radical nephrectomy for renal cancers of 4.7 cm. They found no clear evidence that partial nephrectomy was associated with worse cancer control, but suggest that continued follow-up of this cohort is required.

OBJECTIVE

To analyse the survival benefit of resecting local recurrence (LR) of renal cell carcinoma (RCC) in the presence and absence of concomitant metastasis.

PATIENTS AND METHODS

From 1989 to 2004 we identified 34 patients with LRs (2.9%) of the 1165 radical nephrectomies performed for T1–4N0M0 disease. Of these, 18 (53%) had no evidence of metastasis (isolated LR incidence, 1.5%) and 16 (47%) had synchronous metastasis. Of the 18 patients with no metastasis, 11 had complete surgical resection (group I) and seven had nonsurgical therapy (group II). Of the 16 patients with synchronous metastasis, five had surgery (group III) and 11 did not (group IV). Survival was projected using the Kaplan–Meier method and log-rank test for each group.

RESULTS

Eight of the 34 patients (24%) were symptomatic. The T stage of the initial nephrectomy was T1a in two cases, T1b in six, T2 in five, T3a in six, T3b in eight, T4 in six and unknown in one; 22 patients (65%) had clear cell histology. There were no significant differences in median time to LR or the LR size among the groups. The median (range) follow-up was 16.9 (0.5–103.6) months. Of the 11 patients in group I, three remain with no evidence of disease, three are alive with metastatic disease, and five died from disease. By contrast, 21 of the 23 patients (91%) in groups II, III and IV died from disease. The overall estimated 1-, 3- and 5-year survivals were 63%, 31% and 18%. The median survival time was 71.4 months for group I, 9.9 for II, 16.3 for III, and 11.8 for IV (P < 0.01) with a 5-year survival of 62% for group I and 0% for groups II, III, and IV.

CONCLUSIONS

LR after radical nephrectomy is rare (2.9%) and has a poor prognosis. The presence of synchronous metastasis and nonoperative therapy are related to these low survival rates. However, if there is no metastatic disease, complete surgical resection of LRs is associated with improved survival.