Abstract
Introduction
Local retroperitoneal recurrence (RPR) after racial nephrectomy (RN) of renal cell
carcinoma (RCC) remains a therapeutic challenge and has a poor prognosis. We aimed
to compare the oncological outcomes of patients with RPR treated with RPR surgery
or targeted therapy alone and assess the prognostic factors of these patients.
Patients and Methods
This is a retrospective multi-center study of patients with RPR after prior RN treated
with or without surgical treatment from 2008 to 2020. RPR of RCC is defined as an
ipsilateral recurrence confined to the renal fossa, adrenal gland or retroperitoneal
lymph nodes after prior nephrectomy, which was diagnosed by cross-sectional imaging.
Clinical and pathological features, perioperative complications were reported using
descriptive statistics. Cancer-specific survival (CSS) was evaluated by Kaplan-Meier
method and studied using Cox proportional hazards model.
Results
Median follow-up period was 35 months (IQR 20-61) for the RPR surgery group and 23
months (IQR 9-40.5) for the targeted therapy group. No patients had distant metastatic
disease at the time of RPR diagnosis. Treatment with RPR surgery resulted in significantly
longer CSS than targeted therapy alone (P < .001). In multivariable analysis, high Fuhrman grade, size of RPR tumor, mixed
type of RPR, multiple recurrence lesions and the absence of RPR surgery were associated
with a significantly increased risk of death from RCC.
Conclusion
Aggressive surgical resection of RPR after RN represents a potentially curative treatment
for selected RCC patients without synchronous metastases, resulting in significantly
longer CSS than targeted therapy alone.
Keyword
Abbreviations:
RPR (Retroperitoneal recurrence), RN (Radical nephrectomy), RCC (Renal cell carcinoma), CSS (Cancer-specific survival), RFS (Recurrence free survival)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinical Genitourinary CancerAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Features associated with recurrence beyond 5 years after nephrectomy and nephron-sparing surgery for renal cell carcinoma: development and internal validation of a risk model (PRELANE score) to predict late recurrence based on a large multicenter database (CORONA/SATURN Project).Eur Urol. 2013; 64: 472-477
- Local recurrence after radical nephrectomy for kidney cancer: management and prediction of outcomes. a multi-institutional study.J Surg Oncol. 2014; 109: 126-131
- Renal fossa recurrence after nephrectomy for renal cell carcinoma: prognostic features and oncological outcomes.BJU Int. 2017; 119: 116-127
- Local recurrence after curative surgical treatment of renal cell cancer: a study of 91 patients.Clin Genitourin Cancer. 2016; 14: e379-e385
- Surgical Management of Local Retroperitoneal Recurrence of Renal Cell Carcinoma after Radical Nephrectomy.J Urol. 2015; 194: 316-322
- Systematic Review of the Management of Local Kidney Cancer Relapse.Eur Urol Oncol. 2018; 1: 512-523
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- American Cancer Society.: AJCC cancer staging handbook: from the AJCC cancer staging manual.7th ed. Springer, New York2010: 718 (xixp)
- Local Recurrence Following Resection of Intermediate-High Risk Nonmetastatic Renal Cell Carcinoma: An Anatomical Classification and Analysis of the ASSURE (ECOG-ACRIN E2805) Adjuvant Trial.J Urol. 2020; 203: 684-689
- Outcome of isolated renal cell carcinoma fossa recurrence after nephrectomy.J Urol. 2000; 164: 322-325
- Laparoscopic resection of local recurrence after previous radical nephrectomy for clinically localized renal-cell carcinoma: perioperative outcomes and initial observations.J Endourol. 2010; 24: 1609-1612
- Laparoscopic adrenalectomy for metachronous metastases after ipsilateral nephrectomy for renal-cell carcinoma.J Endourol. 2011; 25: 1323-1327
- Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for patients with renal cell carcinoma: Randomized, double-blind, phase III KEYNOTE-564 study.J Clin Oncol. 2021; 39 (supplabstr LBA5)
Article info
Publication history
Published online: October 26, 2022
Accepted:
October 16,
2022
Received in revised form:
October 14,
2022
Received:
August 11,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
