IN THE NAME OF GOD

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 multicentricity or 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

Renal fossa

Ipsilateral adrenal gland

Ipsilateral retroperitoneal lymph nodes

http://www.em-consulte.com/showarticlefile/121499/f_migno_01.jpg

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.

THE END