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Surgical Management and Oncologic Outcomes for Local Retroperitoneal Recurrence of Renal Cell Carcinoma After Radical Nephrectomy

  • Author Footnotes
    # These authors have contributed equally to this work.
    Jiwei Huang
    Correspondence
    Address for correspondences: Jiwei Huang, MD, Wei Xue, MD, Yiran Huang, MD, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai 200127, China.
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Yueming Wang
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Cuijian Zhang
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, First Hospital of Peking University, Beijing, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Xiaoyi Hu
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Ping Wang
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Guohai Shi
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    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
    Liang Dong
    Footnotes
    # These authors have contributed equally to this work.
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Jin Zhang
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Wen Kong
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Yonghui Chen
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Dan Xia
    Correspondence
    Address for correspondence: Dan Xia, MD, Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
    Affiliations
    Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China
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  • Jianming Guo
    Correspondence
    Address for correspondence: Jianming Guo, MD, Department of Urology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 20032, China.
    Affiliations
    Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, P. R. China
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  • Wei Xue
    Correspondence
    Address for correspondences: Jiwei Huang, MD, Wei Xue, MD, Yiran Huang, MD, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai 200127, China.
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Yiran Huang
    Correspondence
    Address for correspondences: Jiwei Huang, MD, Wei Xue, MD, Yiran Huang, MD, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Road, Pudong District, Shanghai 200127, China.
    Affiliations
    Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P. R. China
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  • Zhisong He
    Correspondence
    Address for correspondence: Zhisong He, MD, Department of Urology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China.
    Affiliations
    Department of Urology, First Hospital of Peking University, Beijing, P. R. China
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  • Author Footnotes
    # These authors have contributed equally to this work.
Published:October 26, 2022DOI:https://doi.org/10.1016/j.clgc.2022.10.010

      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)
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